Medicine Cabinet -Dabigatran

Dabigatran is a relatively new anti-thrombin drug. Dabigatran is in a class of anticoagulant medications called direct thrombin inhibitors. It works by preventing blood clots from forming in the body.

It is a blood thinner used to treat deep vein thrombosis (a blood clot, usually in the leg) and pulmonary embolism (a blood clot in the lung) in adults and children. It is used to prevent blood clots following hip or knee replacement and in those with a history of prior clots. routine close monitoring of clotting function like some other drugs.

It is Dabigatran reversibly binds itself to the active site on the thrornbin molecule, preventing thrombin mediated activation of coagulation factors. It reduces the formation of blood clots and enhances the

body's capacity to breakdown clots(fibrinolysis). It can inactivate thrombin even if it is fibrin bound.

Dabigatran is prescribed for:

• Cerebrovascular accident

• Deep vein thrombosis

• Recurrent deep vein thrombosis

• Pulmonary embolism

• Venous thromboembolism

• Systemic embolism

Rx

The drug is available in capsule form in 75 mg, 110 mg and 150 mg for adults and oral pellets form in 20 mg, 30 mg, 40 mg,50 mg, 110 mg and 150 mg for children, 3 months of age or older.

Dabigatran has a half-life of approximately 12 to 14 hours and exerts a maximum anticoagulation effect within 2 to 3 hours after ingestion. It is administered twice daily.

Benefits

Dabigatran has potentially greater efficacy, simple dosing and better safety profile particularly with regard to intra-cerebral haemorrhage. It does not require routine close monitoring of clotting function like some other drugs. used as an alternative to warfarin

(another anticoagulant drug) and does not require monitoring by blood tests.

Disadvantage

Daily dosing cost is around INR 13 per day which far exceeds the cost

of drugs like warfarin which is INR 1 per day.

Side effects

The primary side effect is haemorrhage (internal or external bleeding). It may also cause dyspepsia (upper abdomen pain) and gastritis.

Word of caution

Dabigatran should not be taken by those who:

• Have had an operation on spine

• Have an increased risk of bleeding due to clotting disorder

• Have a haemorrhage in the brain

• Are pregnant or lactating and breast feeding mothers

• Have chronic kidney disease

• Have mechanical heart valve

Antidote

Idarucizumab is an antidote for Dabigatran for a patient (already on Dabigatran) who needs to undergo an imergency surgery.

Dr Abhay Khode is a Consulting Cardiologist.