A DOAC Deep Dive: Dabigatran

Updated January 2020

For the past several decades, warfarin has been the go-to anticoagulant drug, but newer treatments have emerged in the form of direct oral anticoagulants (DOACs). DOACs are considered more effective and safer than warfarin, especially with regard to serious bleeding episodes. These anticoagulants include apixaban, dabigatran, edoxaban, rivaroxaban, and betrixaban.

Here’s an inside look at dabigatran.

What is it?

Dabigatran, also known as Pradaxa^® is a pill taken twice a day every 12 hours. It reduces the risk of blood clot-related issues, such as deep vein thrombosis (DVT), pulmonary embolism (PE), and stroke from atrial fibrillation (Afib not caused by a heart valve problem).

How does it work?

Dabigatran is a direct thrombin inhibitor. This means that it works to block a clotting agent known as thrombin. Dabigatran binds itself to thrombin molecules, preventing them from initiating a blood clot.

“When a blood clot forms, one of the main ingredients for it is fibrin. Fibrin forms when it’s converted from its precursor, fibrinogen. Another entity called thrombin needs to be activated for the conversion to take place.” explained Dr. Azhar Ahmad, the executive director of clinical development and medical affairs at Boehringer Ingelheim. “Dabigatran inhibits what the thrombin is doing, stops the fibrinogen from forming fibrin, and prevents the blood from clotting.”

What are the risks?

As with any medication, dabigatran has risks. Patients on dabigatran may have a higher risk of bleeding, especially if they’re older than age 75, have kidney problems, or have had recent stomach or intestinal bleeding or stomach ulcers. Patients on dabigatran should always talk to a healthcare provider before having any type of surgery, medical procedure, or dental procedure. Dabigatran may also cause patients to bruise more easily.

In the event of major or life-threatening bleeding, dabigatran can be reversed with an antidote called idarucizumab (Praxbind^®).

What are the benefits?

Dabigatran is an effective and safe alternative to warfarin. In the RE-LY trial, dabigatran significantly reduced the risk of stroke in patients with nonvalvular Afib compared with warfarin. In 2009, the RE-COVER study compared dabigatran to warfarin based on how well the drugs treated acute venous thromboembolism (VTE). The randomized, double-blind noninferiority trial showed that dabigatran was just as effective as warfarin in treating VTE. Then in 2013, researchers followed up with the RE-COVER II study and determined that dabigatran had a lower risk of bleeding than warfarin when used to treat VTE.

 

Interested in learning more?

If you believe that dabigatran may be a good fit for you, talk to your healthcare provider about your options. NATF’s Anticoagulation Comparison Chart is a great tool that you can use to discuss which anticoagulant is right for you.

This DOAC Deep Dive is for informational purposes only.

Boehringer Ingelheim is a sponsor of NATF. They had no influence over the content of this article beyond providing nonbiased scientific information about dabigatran.