Dabigatran Disease Interactions

The use of dabigatran is contraindicated in patients with mechanical prosthetic valves. The use of dabigatran for the prophylaxis of thromboembolic events in patients with atrial fibrillation in the setting of other forms of valvular heart disease, including the presence of a bioprosthetic heart valve has not been studied and it is not recommended.

The use of thrombin inhibitors is contraindicated in the presence of active major bleeding. Additionally, these drugs should be used with caution in patients with disease states associated with an increased risk of bleeding.

The anticoagulant activity and half-life of dabigatran may increase in patients with renal impairment. It is recommended to decrease the dose in patients with severe renal impairment (CrCl 15-30 mL/min). No dose adjustment is recommended in patients with mild or moderate renal impairment. Dosing recommendations for patients with CrCl <15 mL/min or on dialysis has not been established. Care should be exercised when using this agent in patients with renal impairment or on dialysis.

Direct acting oral anticoagulants including factor Xa inhibitors and some thrombin inhibitors as dabigatran, are not recommended for use in patients with antiphospholipid syndrome (APS). Treatment with these drugs has been associated with increased rates of recurrent thrombotic events, especially in patients with triple positive APS.