Keywords: dabigatran, anticoagulant, thrombin inhibitor (PubMed Search)
Dabigatran is a new oral anticoagulant (direct thrombin inhibitor) which is being marketed as the new drug to replace warfarin in many cardiac patients. You'll hear much more about it in the coming year, but for now you should know the main advantage and disadvantage:
1. advantage: no need to check levels, e.g. INRs
2. disadvantage: no reversal agent; if a patient is actively bleeding, all you can do is to hold further doses and provide supportive therapy, e.g. tranfusions; hemodialysis is another option, but not ideal to place new dialysis catheters emergently in patients that are coagulopathic!
This second point, the disadvantage of having no reversal agent, is potentially a big issue, especially in older patients at risk for falls. Stay tuned for more information...