Dabigatran: New competition for Warfarin

When asked what the main pharmocalogical treatment is for coagulopathies you may think of Coumadin (Warfarin). There is a new drug called Dabigatran (Pradaxa) which is being used to prevent stroke in atrial fibrillation patients.

The benefit of this new drug over Coumadin is that there isn’t a need to have international normalized ratio (INR) monitored on a regular basis. The INR is a measurement of the bloods clotting tendencies. Based on the patients ratio, the doctor will determine the amount of Warfarin to prescribe and adjust as the ratio’s change.

Dabigatran benefits includes being a more predictable pharmokinetic, one size dose for all patients and no need for INR monitoring.  It is a direct thrombin inhibitor that works more directly on Thrombin (IIa). Compared to Warfarin it is as well found to be equal and in some cases better at preventing strokes.

While Warfarin is being shown as a more difficult medications to prescribe compared to Dabigatran it is easier to reverse. By providing blood plasma and vitamin K , the anticoagulation effects can be reversed. Therefore in the event of a major bleed treatment options are readily available in the emergency room.

This being said, there are treatment options for Dabigatran patients with a hemorrhage. It is recommended by Hennepin Medical Center has a protocol that can lead to treatment to include fresh frozen plasma, factor VIIa and dialysis. As Nathaniel L. Scott, MD says that:

“Many unanswered questions still exist. For example most speculation of what reversal agents may work is exactly that, speculation. The proposed agents are grounded in their physiologic basis, but in terms of what actually works clinically is not known.”

Learn more from the references below. I would recommend watching the Reversal of Dabigatran video first.

References:

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