Dabigatran - A New Chapter in Anticoagulation

Shameer      Ahmed; Vadim      Levin; Robert      Malacoff; Matthew      W. Martinez

Abstract

For the last 60 years warfarin has been the cornerstone for chronic anticoagulation in prevention of ischemic strokes and systemic embolization. Warfarin therapy has several limitations including frequent monitoring and various food and significant drug interactions, which make it a less than ideal chronic oral anticoagulant. The continued search for safe, effective, medications with predictable pharmacokinetic profiles has led to newer alternatives. Dabigatran is a potent reversible, competitive direct thrombin inhibitor which is available as the prodrug, Dabigatran etexilate. It was first approved in Europe and recently in October 2010, the US food and drug administration (FDA) has approved the use of this novel oral anticoagulation for prevention of stroke in those with non valvular atrial fibrillation. This review will cover the chemical structure, mechanism of action, pharmacokinetic profile, clinical trials, dosage, clinical implication and adverse effects of dabigatran.

Keywords: Anticoagulation, atrial fibrillation, BISTRO trial, chemical structure, dabigatran, diract thrombin inhibitors, PETRO trial, pharmacodynamics, pharmacokinetics, Re-Ly trial, RECOVER trial, stroke warfarin