Hematology and Oncology Book

http://www.fpnotebook.com/

Dabigatran

Aka: Dabigatran, Pradaxa
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  1. Mechanism
    1. Oral Direct Thrombin Inhibitor
  2. Pharmacokinetics
    1. Onset: 1 hour post-ingestion
    2. Half-life: 15 hours
    3. Renal excretion
  3. Indications
    1. Atrial Fibrillation
      1. Poor INR control on Warfarin
      2. Barriers to INR monitoring
      3. Warfarin Drug Interactions
    2. Deep Vain Thrombosis (not FDA approved)
      1. (2009) N Engl J Med 361:2342-52
  4. Precautions
    1. No antidote for bleeding
    2. Bleeding typically stops spontaneously within 6-8 hours (but this is too long in exanguination)
      1. Focused control of bleeding
      2. Consider hematology consultation
  5. Dosing
    1. Creatinine Clearance >30 ml/minute: 150 mg twice daily
    2. Creatinine Clearance 15-30 ml/minute: 75 mg twice daily
      1. This dose has not been tested
      2. Do not use in patients with Creatinine Clearance <15 ml/minute
  6. Labs
    1. No routine labs needed (No monitoring of INR needed)
    2. If bleeding, expect the following results:
      1. PTT at 1-2 hours: 2x normal
      2. PTT at 12 hours: 1.5x normal
      3. Expect INR to be increased as well
      4. Thrombin Time is most increased
  7. Efficacy
    1. Slightly more effective than Warfarin in prevention against thrombotic events in Atrial Fibrillation
      1. Prevent 5 more strokes per 1000 patients per year than Warfarin
    2. Appears as effective as Coumadin in Venous Thromboembolism, but not FDA approved for this indication
  8. Disadvantages
    1. Cost: $260/month (contrast with Warfarin which is $80/month with monitoring)
    2. Twice daily dosing
    3. Dyspepsia is common
    4. Not as effective as Warfarin in preventing Myocardial Infarction
      1. Warfarin prevents 2 more Myocardial Infarctions per 1000 patients than Dabigatran
  9. Safety
    1. Fewer intracranial bleeding complications than with Warfarin (Coumadin)
    2. More Gastrointestinal Bleeding complications than with Coumadin
  10. References
    1. (2011) Prescr Lett 18(12):67
    2. (2012) Prescr Lett 19(3):13
    3. (2009) N Engl J Med 361:1139-51
Medication Costs
Pradaxa (on 2/9/2012 at DrugStore.com)
Pradaxa 75mg Capsules #30 for $123.99 ($4.13/unit)
Pradaxa 60 150mg Capsules Bottle #1 for $245.99 ($245.99/unit)
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

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