Dabigatran in NVAF

Question 1

Dabigatran PK

Answer 1

BA = 3-7%, anticoagulation onset =1.5 hr, half-life =12–17 hr

Question 2

Dabigatran NVAF Dose

Answer 2

150 mg twice daily

Question 3

Dabigatran NVAF Dose Adjustments

Answer 3

75 mg twice daily:
CrCl 15–30 mL/min/1.73 m2
CrCl 30–50 mL/min/1.73 m2 with ketoconazole or dronedarone

Question 4

Dabigatran Renal Avoid Use

Answer 4

CrCl < 15 mL/min, Dialysis
CrCl 15–30 mL/min/1.73 m2 with amiodarone, verapamil, ketoconazole, dronedarone, diltiazem, and clarithromycin

Question 5

Dabigatran Drug Interactions

Answer 5

P-gp inhibitors
Rifampin
Chemotherapy agents (applies to all DOACs)– Vinblastine, doxorubicin, imatinib, crizotinib, vandetanib, sunitinib, abiraterone, and enzalutamide

Question 6

Dabigatran Stability

Answer 6

Once the bottle is opened, the medication should be used within 4 months to maintain appropriate potency, and capsules cannot be placed in a pillbox.

Question 7

Converting from Dabigatran to Warfarin

Answer 7

CrCl ≥ 50 mL/min/1.73 m2 - Start warfarin 3 days before discontinuing dabigatran
CrCl 31–50 mL/min/1.73 m2 -Start warfarin 2 days before discontinuing dabigatran
CrCl 15–30 mL/min/1.73 m2 - Start warfarin 1 day before discontinuing dabigatran (reasonable for CrCl less than 15)

Question 8

Converting from Warfarin to Dabigatran

Answer 8

Discontinue warfarin and start dabigatran when the INR is < 2

Question 9

Converting from Parenteral Anticoagulants to Dabigatran

Answer 9

Start dabigatran 0–2 hr before the next dose of the parenteral drug was to have been administered (e.g., LMWH) or when a continuously administered parenteral drug is discontinued (e.g., IV UFH)

Question 10

Converting from Dabigatran to Parenteral Anticoagulant

Answer 10

wait 12 hr (CrCl > 30 mL/min/1.73 m2) or 24 hr (CrCl < 30 mL/min/1.73 m2) after the last dose of dabigatran before initiating treatment with a parenteral anticoagulant