Dabigatran must be used carefully: literature review and recommendations for management of adverse events

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.

Keywords:

• adverse events
• dabigatran
• allergic reactions
• bleeding
• esophageal injury

Acknowledgments

Shan Lin’s deepest gratitude goes first and foremost to Professor Wei Guan, Shan Lin’s supervisor, for her constant encouragement and guidance. She guided Shan Lin along with all those who helped during the writing of this thesis. Without her consistent and illuminating instruction, this thesis could not have reached its present form. This review was funded by QingHai Department of Science and Technology, the Grant Number: 2017-wjzd-11.

Disclosure

All authors claim no conflicts of interest in this work.