Thrombin Inhibitors
Examples
Dabigatran
Indications
- Prophylaxis of venous thromboembolism following surgery
- Prophylaxis and treatment of DVT and PE
- Prophylaxis of stroke and systemic embolism in non-valvular AF
Contraindications
- Active bleeding
- Oesophageal varices
- Malignant neoplasms
- Recent brain/spine surgery
- Recent intracranial haemorrhage
- Severe liver disease
- Pregnancy and breastfeeding
- Bacterial endocarditis
- Indwelling epidural catheter
- Bleeding disorders
- Bodyweight <50kg
- Elderly
- Recent major trauma
- Renal impairment
Mechanism
Dabigatran is a competitive direct inhibitor of thrombin, thereby inhibiting the coagulation cascade as thrombin is the enzyme required to convert fibrinogen to fibrin.
Administration
Oral
Adverse Reactions
- Abdominal Pain
- Diarrhoea
- Dyspepsia
- Nausea
- Haemorrhage
Interactions
NSAIDS, SSRIs and other anticoagulants increase the risk of bleeding in patients on dabigatran.
Both amiodarone and verapamil interact with dabigatran to increase its exposure, therefore the dabigatran dose may need reduced.
Both amiodarone and verapamil interact with dabigatran to increase its exposure, therefore the dabigatran dose may need reduced.
Education
Patients should be made aware of enhanced risks of bleeding with NSAID use.
Pharmacokinetics
Nil of note
