Dabigatran (brand name: Pradaxa) is one of the newer anticoagulant medications (sometimes called novel oral anticoagulants, or NOACs). We think of anticoagulants as blood-thinning medications, but what they actually do is make it take longer for blood to clot. This is important for people who have atrial fibrillation (Afib or AF) and, therefore, are at increased risk for stroke. If you have Afib, your doctor may have prescribed an anticoagulant to reduce your risk for stroke.

The benefit of anticoagulant medications is that they keep the blood from clotting. This is also a risk that comes with taking anticoagulants: they can prevent the blood from clotting when it needs to and can cause dangerous internal bleeding. For most people with Afib, the risk of a blood clot causing a stroke is greater than the risks that come with taking an anticoagulant. The decision to take an anticoagulant – and which one – needs to be carefully evaluated for each person, depending on your individual risk factors, medical history, ability to take medications exactly as prescribed and, in the case of warfarin (Coumadin), willingness to have regular blood tests that are used to monitor the effects of the drug. To learn about the tools doctors use to determine if anticoagulants are appropriate for individual patients, click here.

Several anticoagulants have been approved by the U.S. Food and Drug Administration. Click here to learn more about anticoagulant medications.

This page is meant to familiarize you with dabigatran and how it may be used to prevent blood clots that can cause stroke. Note: This information is intended only to provide an overview. It should not take the place of a doctor’s recommendation. Be sure to speak with your doctor about your condition, symptoms and treatment options.

Benefits & Limitations of Dabigatran

If you are taking the anticoagulant warfarin (Coumadin), you will need to have regular blood tests (called International Normalization Ratio, or INR, checks) to monitor for abnormal bleeding. Dabigatran (and the other newer oral anticoagulants) does not require these tests. Nevertheless, dabigatran (again, like the other newer oral anticoagulants) can cause bleeding complications, some of which can be dangerous. As of fall 2015, warfarin and dabigatran are the only oral anticoagulants that have antidotes available to counteract excessive bleeding and restore the body’s blood-clotting factors. You can learn more about antidotes here.

It is important to note that dabigatran is a shorter-acting medication. This means that it does not stay in the bloodstream for as long as some other drugs. For this reason, it is essential that dabigatran is taken exactly as the directions specify.

As with all medications, it is important to take precautions to ensure that dabigatran does not interact with other medications (prescribed and over-the-counter), supplements and vitamins that you may be taking. This is why it is important to tell your care team about everything you take, including vitamins and supplements.

Dabigatran & Interactions

There are several medications, and types of medications, that people who are taking dabigatran need to avoid in order to prevent potentially dangerous interactions. They include, but are not limited to, the following:

• Mifepristone, sometimes known as RU-486 or the “morning after pill”
• Cyclosporine, which is an immunosuppressant drug used in organ transplantation
• Cobicistat, often used to treat infections in people with the human immunodeficiency virus (HIV)
• Dronedarone, which is an anti-arrhythmic medication that may be prescribed to people with Afib
• Ketoconazole, an antifungal medication
• Rifampin, which is an antibiotic mainly used to treat bacterial infections
• Aspirin
• NSAIDs, which is an abbreviation for “Non-Steroidal Anti-Inflammatory Drugs,” including ibuprofen (Motrin or Advil) and naproxen sodium (Aleve)

Dabigatran has also been known to interact with the herbal supplement St. John’s Wort. If you take any supplements, it is a good idea to make a list of them and bring them with you to your doctor’s appointments. Your care team will inventory what you are taking and let you know if there are any safety issues.

As a reminder, dabigatran has been found to interact with a number of prescription and over-the-counter medications. Be sure to tell your care team about everything you take. It’s also important to be aware of, and monitor yourself, for signs that your body may not be responding as it should to the dabigatran.

Signs of Problems with Taking Dabigatran

If you are taking dabigatran, you should be alert to any changes that could signal a bleeding problem; a negative interaction with a medication, food or supplement; or other issues.

The following symptoms should be considered a medical emergency. If any of these symptoms occur, it is necessary to contact your doctor immediately:

• Severe bleeding (In women, this may include a heavier-than-normal menstrual period.)
• Urine that is red or brown in color
• Frequent nosebleeds
• Stools that appear bloody or black in color
• Joint pain as well as swelling and discomfort in joints
• Bruising when you have not taken a fall or bumped into something
• Vomiting of blood (or of anything that resembles coffee grounds)
• Severe weakness or dizziness
• Severe headache or stomachache

Other symptoms that indicate problems include bleeding of your gums when you brush your teeth, unexplained fever, diarrhea or vomiting that lasts more than 24 hours.

Learn More

If you have been recently diagnosed with atrial fibrillation, it is likely you have a number of questions to ask your doctor about your condition. To get you started, we invite you to download Questions to Ask Your Doctor About Atrial Fibrillation.

If you and your doctor are considering anticoagulant therapy, you may have specific questions about how it will affect you. Some common questions are provided in SecondsCount’s article on What You Need to Know About Anticoagulant Medications.