Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism

Dabigatran etexilate (Pradaxa, Boehringer Ingelheim) is an oral direct thrombin inhibitor that specifically and reversibly inhibits thrombin, a key enzyme in blood clot formation. It is licensed for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE in adults. The recommended dosage of dabigatran etexilate is 300 mg (150 mg twice daily) following treatment with a parenteral anticoagulant for at least 5 days. For people aged 80 years or older and for people having verapamil, the recommended dose is 220 mg (110 mg twice daily). In people aged 75 to 80 years, people with moderately reduced kidney function, people with gastritis, esophagitis or gastroesophageal reflux, and people at increased risk of bleeding, either dose (300 mg or 220 mg) can be given based on an individual assessment. Dabigatran etexilate is contraindicated in people with severely reduced kidney function.

The most common adverse reaction to dabigatran etexilate is bleeding, although indigestion is also common. For full details of adverse reactions and contraindications, see the summary of product characteristics.

Dabigatran etexilate costs £65.90 for a 60‑capsule pack of the 150 mg or 110 mg doses (excluding VAT; BNF 67) and costs £2.20 per day of treatment. Costs may vary in different settings because of negotiated procurement discounts.