Dabigatran

Abstract Dabigatran is a direct oral anticoagulant that acts through specific and reversible inhibition of thrombin. It has been developed as a fixed-dose, modern alternative to vitamin K antagonists such as warfarin. Dabigatran does not require frequent blood testing or dose adjustments. The main indication for dabigatran is the prevention of stroke and systemic embolism in patients with atrial fibrillation and risk factors for stroke. Furthermore, there is high-quality evidence supporting its use in patients with atrial fibrillation undergoing percutaneous coronary intervention or catheter ablation. Dabigatran has also received approval for the prevention of venous thromboembolism after major orthopaedic surgery and recurrent venous thromboembolism, and the treatment of venous thromboembolism. Dabigatran is contraindicated in patients with severe renal impairment (creatinine clearance <30 mL/min), and in patients with moderate-to-severe mitral stenosis or with a mechanical heart valve prosthesis. Idarucizumab is a monoclonal antibody fragment that specifically reverses the anticoagulant activity of dabigatran.