title: A proposal for dose-adjustment of dabigatran etexilate in atrial fibrillation guided by thrombin time.
abstract: Dabigatran is an oral anticoagulant that is increasingly used for atrial fibrillation (AF). Presently, many authorities state that routine laboratory coagulation monitoring is not required. However, data have recently been published demonstrating that higher trough plasma dabigatran concentrations are associated with lower thromboembolic and higher haemorrhagic event rates. Using these data, we simulate a range of AF patients with varying risks for these events and derive a target range of trough plasma dabigatran concentrations (30-130 μg l(-1) ). Finally, we propose that a conventional screening coagulation assay, the thrombin time (TT), can be used to discern whether or not patients are within this range of dabigatran concentrations.
authors.affiliation: Department of Clinical Pharmacology, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Paul K L
authors.initials: PK
authors.lastname: Chin
authors.forename: Daniel F B
authors.initials: DF
authors.lastname: Wright
authors.forename: David M
authors.initials: DM
authors.lastname: Patterson
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Doogue
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Begg
mesh_terms: D001281:Atrial Fibrillation / Q000188:drug therapy*; D001562:Benzimidazoles / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D000069604:Dabigatran; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods; D065427:Factor Xa Inhibitors / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D011725:Pyridines / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D013918:Thrombin Time; D013923:Thromboembolism / Q000517:prevention & control
chemical_list: D001562:Benzimidazoles; D065427:Factor Xa Inhibitors; D011725:Pyridines; D000069604:Dabigatran
keywords: atrial fibrillation; blood coagulation; dabigatran; dosing; monitoring