Dabigatran (Pradaxa®)

What is Dabigatran?

Dabigatran is an oral anticoagulant. Anticoagulants are medicines that treat and prevent blood clots.

You are taking Dabigatran for:

Atrial fibrillation, to prevent stroke

• Deep vein thrombosis (DVT)
• Pulmonary embolism (PE)
• Prevention of PE or DVT (after hip or knee surgery)
• Other

Your dose of Dabigatran is:

• 110 mg twice daily
• 150 mg twice daily
• 150 mg twice daily, following 5-10 days of an injectable anticoagulant
• 220 mg once daily

Practical tips for taking Dabigatran:

Dabigatran should be taken as your doctor or pharmacist has told you.
The capsule must be swallowed whole – do not chew it or break it.
You can take it with or without food.

What if you miss a dose?

It is important to take Dabigatran as scheduled. Be sure you fill your prescription on time. If you miss a dose:

• Within 6 hours, take your missed dose and then continue your regular dosing.
• More than 6 hours, skip the dose and take the next dose at the usual time.
• Do not take a double dose.

Does Dabigatran have side effects?

Most people do not experience side effects. The most common side effects with Dabigatran are:

• Stomach upset/pain/heartburn occurs in about 1 out of 10 people. If this happens, try taking Dabigatran with food (especially larger meals).
• If food does not help, speak with your doctor
• All anticoagulants increase the risk of bleeding. Bleeding can be minor or major:
• Minor bleeding stops on its own and does not last long. Examples of minor bleeding include: nose bleeding, gum bleeding, bruising, etc.
• Major bleeding (see below) is more serious, requires medical attention, and stopping Dabigatran at least temporarily.

When should you contact your doctor or pharmacist urgently?

If you have any of the following symptoms of bleeding:

• Becoming pale, very weak and tired, shortness of breath or chest pain
• Black/tarry or bloody bowel movements
• Bleeding from the rectum
• Pink/red or dark colored urine
• Excessive menstrual bleeding
• Coughing or vomiting up blood
• Any bleeding that won’t stop
• Physical injury such as head injury, broken bones, car accidents, sports injuries

What should you discuss with your health care providers?

Be sure to tell all your health care providers that you are taking Dabigatran if you need surgery, dental work, chiropractic manipulation, any invasive procedure, or will be exposed to any bleeding risk

• If you start any new medicine including an over the counter medicine.
• Playing contact sports or any activities that may put you at risk of injury or bleeding is not recommended, and should be discussed.
• Situations where a blood thinner may need to be reversed (i.e. medical emergency).
• Availability of reversal agent.

Does Dabigatran require any kind of monitoring?

No regular blood testing to check the level of Dabigatran is needed. Your doctor does need to check how well your kidneys are working by doing a blood test called “creatinine”. Your kidney function must be known before starting Dabigatran. It should also be checked at least once a year and more often if your kidneys are not working well

• Patients taking Dabigatran do require follow-up with their physician
• Carrying a wallet card or ID bracelet that states you are taking Dabigatran is a good idea. In case of emergency, this would be important for health care providers to know.

Can dabigatran be reversed in the event of an emergency?

Idarucizumab, is an antidote specific for Dabigatran, and is indicated for patients treated with dabigatran when rapid specific reversal of the anticoagulant effects of Dabigatran is required for:

• For emergency surgery/urgent procedures
• In life-threatening or uncontrolled bleeding
• Intravenous (IV) solution packaged as two vials of 2.5 grams per 50 mL
• Idarucizumab is for emergency hospital use

Take Away Message

• Dabigatran reduces your risk of developing blood clots.
• Remember to take Dabigatran on time and refill your prescription early.
• Missing doses will reduce the effectiveness of this medicine. Immediately report symptoms of blood clot, such as stroke, to an emergency room.
• Do not stop taking Dabigatran without talking to your doctor.
• Immediately report any unusual or major bleeding
• Changes to your health and/or medicines may affect Dabigatran. Contact your doctor or pharmacist if these occur.
• Having an ID bracelet and wallet card with your medical information is a good idea.

Acknowledgment:

The above information was directly obtained from the Thrombosis Canada website (thrombosiscanada.ca).