Dabigatran

Key facts

• Dabigatran (brand name Pradaxa) is a direct oral anticoagulant, or DOAC. It blocks thrombin, the enzyme that forms the fibrin mesh holding a clot together.
• You take it as a fixed dose, usually twice daily, swallowed whole with a full glass of water, and it needs no routine blood testing.
• Never stop dabigatran without medical advice. Stopping it suddenly sharply raises your risk of a stroke or clot; your prescriber will tell you exactly when to pause it before surgery.
• Seek urgent care for black or bloody stools, blood in urine or vomit, a sudden severe headache, or bruising that spreads.

What dabigatran treats

Dabigatran prevents stroke and blood clots in people with atrial fibrillation. It treats deep vein thrombosis and pulmonary embolism and prevents them recurring after an initial course of treatment. It is also used for several weeks after hip or knee replacement surgery to prevent clots forming in the leg veins.

How dabigatran works

Thrombin converts fibrinogen into fibrin, the mesh that holds a blood clot together. Dabigatran binds directly to thrombin and blocks it, so far less fibrin forms and clots are much slower to develop. Because it acts on one specific target at a fixed dose, its effect is predictable and, unlike warfarin, needs no routine blood-level monitoring.

Before you take it

• Your prescriber will lower your dose or avoid dabigatran if you have reduced kidney function; it is cleared mainly by the kidneys and can build up to dangerous levels if they decline.
• Swallow the capsules whole. Do not open, break or chew them, since this releases the drug too quickly and raises bleeding risk.
• Keep capsules in their original, tightly closed bottle; they absorb moisture if left in blister packs or pill organizers and lose potency.
• Dabigatran has far fewer food interactions than warfarin and needs no vitamin K monitoring. It still interacts with other blood thinners and certain antiseizure and antifungal medicines that change its levels.

Side effects

Common effects include indigestion, stomach pain or heartburn, easy bruising, and minor nosebleeds.

Stop and seek urgent medical care for any of these:

• Black or tarry stools, blood in urine or vomit, or bleeding that will not stop.
• A sudden severe headache, confusion, or weakness on one side of the body.
• Unusual or spreading bruising, or heavy bleeding after a minor injury.

Safety essentials

• Do not stop taking dabigatran abruptly or skip doses without medical advice. Stopping suddenly is strongly linked to clots and stroke; ask your prescriber when to pause it before any surgery or dental work.
• Kidney function determines your dose. Tell your prescriber about any new kidney problem or dehydration, since worsening function can mean your current dose is now too high.
• Dabigatran still carries a serious bleeding risk even though it needs none of the food restrictions warfarin does; tell every clinician you take it before any procedure.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.