Oral Direct Thrombin Inhibitors

Dabigatran directly inhibits thrombin, which reduces coagulation.  Dabigatran is used for stroke prophylaxis in atrial fibrillation.  Bleeding is obviously a risk and clotting risk increases upon discontinuation.

Class Drugs

• Dabigatran

Class Mechanism of Action

Direct thrombin inhibitor

• Inhibits free and clot bound thrombin

Site of action of direct thrombin inhibitors in the coagulation cascade.

Class Applications

Stroke prophylaxis in atrial fibrillation

Class Adverse Effects

Bleeding, can be life threatening

• Idarucizumab is the reversal agent, a monoclonal antibody

GI upset, esophagitis, abdominal pain

Avoid abrupt discontinuation as risk of clotting increases

Contraindicated in patients with mechanical heart valves and discouraged in patients with bioprosthetic valves

Drug Table

Drug Name	Application	Comments	Image
Dabigatran			"Da Big Tram"