[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Direct oral anticoagulants (DOACs)](https://durgical.com/en/pharmacology/classes/direct-oral-anticoagulants/) › Dabigatran [Pharmacology](https://durgical.com/en/pharmacology/) · [Direct oral anticoagulants (DOACs)](https://durgical.com/en/pharmacology/classes/direct-oral-anticoagulants/) # Dabigatran An oral anticoagulant that blocks thrombin directly. It is cleared mainly by the kidneys and has its own antidote, idarucizumab. Updated 2026-11-01 - Class: [Direct oral anticoagulants (DOACs)](https://durgical.com/en/pharmacology/classes/direct-oral-anticoagulants/) - Enzyme: Thrombin (coagulation factor IIa) - ATC code: B01AE07 - WHO Model List of Essential Medicines Also called: dabigatran etexilate ✂**Thrombin (coagulation factor IIa)**Dabigatran ⓘ The figure shows a dabigatran-series inhibitor (the ethyl ester of the dabigatran molecule) in thrombin's active site; the crystal also holds a hirudin fragment. **Target in 3D:** Thrombin (coagulation factor IIa). PDB structure 1KTS (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/1KTS) · Drag to rotate · pinch to zoom ## Mechanism of action Dabigatran etexilate is a prodrug that esterases convert into dabigatran. Dabigatran is a direct thrombin inhibitor: it blocks both free thrombin and thrombin bound inside the clot. Thrombin can then no longer turn fibrinogen into fibrin, and thrombin-driven platelet aggregation falls. - Esterases turn the prodrug into active dabigatran - Dabigatran blocks thrombin, free and inside the clot - Less fibrin forms and platelets aggregate less - Clots form and grow less: lower risk of stroke and VTE ## Pharmacokinetics **Absorption** Low oral bioavailability; capsules are swallowed whole, since opening or chewing them raises exposure. **Distribution** Low binding to plasma proteins, so haemodialysis can remove part of it. **Metabolism** Not a CYP substrate; partly conjugated to active acyl glucuronides. The prodrug is a P-glycoprotein substrate. **Elimination** Mainly by the kidneys (about 80% of its clearance). **Half-life** About 12 to 17 hours, longer in kidney impairment. **Onset and duration** Peak levels about an hour after a dose, later with a fatty meal. ## Indications - Prevention of stroke and embolism in non-valvular atrial fibrillation. [Atrial fibrillation →](https://durgical.com/en/conditions/atrial-fibrillation/) - Treatment and prevention of recurrent deep vein thrombosis; prevention after hip replacement. [Deep vein thrombosis →](https://durgical.com/en/conditions/deep-vein-thrombosis/) - Treatment and prevention of recurrent pulmonary embolism. [Pulmonary embolism →](https://durgical.com/en/conditions/pulmonary-embolism/) ## Adverse effects ### Common - Dyspepsia and gastritis-like symptoms (heartburn, upper abdominal pain) - Bleeding (bruising, nose, gums) - Nausea ### Serious (rare, important) - Major and gastrointestinal bleeding - Spinal or epidural haematoma with neuraxial anaesthesia or puncture - Higher risk of clots when stopped early ## Contraindications - Mechanical prosthetic heart valves - Active pathological bleeding - Serious allergy to dabigatran - Triple-positive antiphospholipid syndrome (not recommended) ## Key interactions **P-glycoprotein inhibitors (dronedarone, ketoconazole)** Raise dabigatran levels, most of all when kidney function is reduced. **P-glycoprotein inducers (rifampicin)** Lower levels and the protection against clots; generally avoided. **Aspirin, clopidogrel, prasugrel, ticagrelor and NSAIDs** Add to bleeding risk. ## What is monitored - Kidney function before and during treatment - Signs of bleeding - The INR is insensitive to dabigatran; the aPTT or ecarin clotting time are used when its effect must be judged ## Memory aid Dabigatran goes straight for the boss of the cascade, thrombin, and leaves by the kidney door: when that door narrows, it stays longer. ## Test yourself Think of the answer, then tap the question to see it. ## What is the specific antidote for dabigatran and how does it work? Idarucizumab, a humanised antibody fragment that binds dabigatran more tightly than dabigatran binds thrombin, neutralising its effect. ## Why does kidney function weigh more for dabigatran than for other DOACs? The kidneys handle most of its clearance, so in kidney impairment it builds up, its half-life lengthens and bleeding risk rises. ## Why are dabigatran capsules not opened? Opening, breaking or chewing them increases how much is absorbed, raising exposure and bleeding risk. ## Which adverse effects are most common with dabigatran? Gastrointestinal symptoms such as dyspepsia and gastritis-like discomfort, and bleeding. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/pharmacology/dabigatran/) ## Related drugs - [Rivaroxaban](https://durgical.com/en/pharmacology/rivaroxaban/) - [Warfarin](https://durgical.com/en/pharmacology/warfarin/) - [Heparin](https://durgical.com/en/pharmacology/heparin/) ## Related conditions - [Atrial fibrillation](https://durgical.com/en/conditions/atrial-fibrillation/) - [Deep vein thrombosis](https://durgical.com/en/conditions/deep-vein-thrombosis/) - [Pulmonary embolism](https://durgical.com/en/conditions/pulmonary-embolism/) [← Back to the class: Direct oral anticoagulants (DOACs)](https://durgical.com/en/pharmacology/classes/direct-oral-anticoagulants/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [DailyMed - DABIGATRAN- dabigatran etexilate capsule](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6f79088b-b353-485a-9df4-6f5088f5bd0f) (DailyMed (U.S. National Library of Medicine), 2026); [Dabigatran: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a610024.html) (MedlinePlus (U.S. National Library of Medicine), 2025); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/?query=dabigatran) (World Health Organization, 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/dabigatran/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/dabigatran/