The ability of Staphylococcus aureus to clot plasma through conformational activation of prothrombin by staphylocoagulase is used to distinguish S. aureus from coagulase-negative staphylococci. We show that while the direct thrombin inhibitor dabigatran inhibits staphylocoagulase activity, the clinical use of dabigatran etexilate is not expected to interfere with direct tube coagulase testing.Since the early notion, developed more than a century ago, that the ability to clot plasma correlates with the pathogenic potential of staphylococci (3,14), this phenomenon has been used to distinguish Staphylococcus aureus from less virulent, coagulase-negative staphylococci. Although the use of new molecular methods for rapid identification of S. aureus from blood culture bottles is expanding (15, 17), detection of coagulase activity by direct tube coagulase (DTC) testing remains a costeffective, easy to perform, and reliable method for early detection of S. aureus in blood culture broth with a Gram stain result suggestive of staphylococci (10,13,16,23). Since false-negative results increase the therapeutic delay, the carryover of contaminants from either the culture broth or the patient's plasma that interfere with the tube test clotting reaction has to be avoided (23).Clotting occurs when fibrinogen is converted into fibrin by thrombin. Under physiological conditions, the proteolytic activation of the inactive precursor prothrombin into thrombin is the final step in the tightly regulated coagulation cascade. Staphylocoagulase secreted by S. aureus directly binds to prothrombin to form the staphylothrombin complex and thus bypasses the coagulation cascade and its physiological regulation (6). As a consequence of this unique nonproteolytic direct thrombin activation, treatment with heparins, vitamin K antagonists, or the thrombin inhibitor hirudin does not interfere with staphylothrombin function (9) and is of no concern for DTC testing.In view of the recent availability and increasing clinical use of the new direct thrombin inhibitor dabigatran etexilate, we studied whether dabigatran inhibits staphylocoagulase and whether clinical use of dabigatran etexilate is expected to interfere with DTC testing.To test these possibilities, we measured coagulation of citrated human plasma as the change in absorbance at 405 nm (A 405 ) after the addition of purified staphylocoagulase (3 nM) in the presence of increasing concentrations (0, 0.625, 1.25, 2.5, 5, and 10 nM) of dabigatran (Boehringer Ingelheim