<p>Dabigatran must be used carefully: literature review and recommendations for management of adverse events</p>

Abstract

Atrial fibrillation increases the risk of stroke and death. The vitamin-K antagonist warfarin is recommended for patients with atrial fibrillation, but vitamin-K antagonists are cumbersome to use. Therefore, an effective, safe and convenient new anticoagulant is needed. Dabigatran acts by inhibiting free and fibrin-bound thrombin directly. It is an oral anticoagulant that was approved by the US Food and Drug Administration. The oral anticoagulant dabigatran has been used increasingly due to its good tolerance, predictable pharmacokinetics, effective anticoagulant effects, and absence of requirement of coagulation monitoring. However, an increasing prevalence of adverse events has been reported, some of them quite serious. Therefore, we searched and reviewed the literature on dabigatran with regard to adverse events, and proposed solutions to prevent and reduce the chance of adverse events occurring.

Dabigatran-induced acute liver injury in older patients: case report and literature review

“…However, the mechanism of hepatotoxicity of DOACs still remains unknown 7 . A possible explanation for liver dysfunction caused by dabigatran may be that first-pass elimination occurs in the liver 8 . The RE-LY trial showed that impairment of liver function caused by dabigatran did not occur more frequently than with warfarin 2,8 .…”

“…A possible explanation for liver dysfunction caused by dabigatran may be that first-pass elimination occurs in the liver 8 . The RE-LY trial showed that impairment of liver function caused by dabigatran did not occur more frequently than with warfarin 2,8 . In a systematic review and meta-analysis of phase III randomized controlled trials, Caldeira et al concluded 9 .…”

Dabigatran-induced esophageal injury: a case report

“…Recent studies on DIE also showed that a sizable majority of patients are elderly individuals. [ 5 ] However, the patient in our report was a younger male who developed esophagitis despite correct ingestion of dabigatran and the prophylactic use of pantoprazole. Hence, whether proton-pump inhibitors (PPIs) can alleviate esophageal injury caused by local dissolution of dabigatran remains unclear, and the mechanism behind DIE still needs to be further explored.…”

Dabigatran Etexilate Induces Cytotoxicity in Rat Gastric Epithelial Cell Line via Mitochondrial Reactive Oxygen Species Production

“…Dabigatran is a novel oral anticoagulant that was approved by the FDA in 2010 [3]. Dabigatran directly inhibits free and fibrin-bound thrombin and exhibits rapid and predictable anticoagulant effects [4,5]. Dabigatran prevents embolic events in patients with non-hemorrhagic stroke and atrial fibrillation and can be used in a safe and effective manner without the need for monitoring and dose adjustment, in contrast to warfarin, which requires continuous monitoring [6].…”