What does it mean for my patient?

Mechanism of action

Indirect mode of action (inhibits the production of blood procoagulant factors (i.e. prothrombin and Factors VII, IX and X), as well as of protein C and protein S

Direct Factor IIa (thrombin) inhibitor (prevents thrombin from converting fibrinogen into fibrin)

Direct Factor Xa inhibitors (prevent Factor Xa from converting prothrombin to thrombin)

Not applicable

Needs to be taken with food

With or without food

With or without food

With or without food for the 10 mg dose; to be taken with food for the 15 and 20 mg doses

With or without food

With or without food

Establishing the most suitable time of day for the patient to take their medication

Time to peak activity

Generally 24 h but can be delayed by 72 - 96 h

0.5 - 2 h

2 - 4 h

3 - 4 h

1 - 2 h

Non-VKA OACs have quicker onset of action compared with warfarin


20 - 60 h

12 - 14 h

5 - 9 h (young individuals); 11 - 13 h (elderly individuals)

~12 h

10 - 14 h

Warfarin has a slower offset of action, meaning it needs to be stopped earlier before surgery

GI tolerability*

No problem


No problem

No problem

No problem

Dabigatran is not appropriate for patients suffering from dyspepsia

Drug interactions (important examples)

Numerous drugs

Contraindicated in patients receiving systemic ketoconazole, ciclosporin, itraconazole and dronedarone; caution needed with amiodarone, posaconazole, quinidine, verapamil, ticagrelor; should be avoided in patients receiving rifampicin, St John’s wort, carbamazepine or phenytoin; contraindicated in patients receiving concomitant anticoagulants

Not recommended in patients receiving azole-antimycotics (such as ketoconazole, itraconazole, voriconazole, posaconazole) or HIV protease inhibitors (e.g. ritonavir); care to be taken with concomitant use of NSAIDs, ASA and PAIs; contraindicated in patients receiving concomitant anticoagulants

Contraindicated (DVT/PE indication)/caution needed (prevention of VTE in patients undergoing elective hip or knee replacement surgery/stroke prevention in AF/VTE secondary prevention indications) in patients receiving rifampicin, phenytoin, carbamazepine, phenobarbital, St John’s wort; not recommended in patients receiving ketoconazole, itraconazole, voriconazole, posaconazole and HIV protease inhibitors (e.g. ritonavir); contraindicated in patients receiving concomitant anticoagulants

Should be used with caution in patients receiving rifampicin; dose reduction in patients receiving ciclosporin, dronedarone, erythromycin, ketoconazole; close scrutiny for bleeding in patients who require chronic treatment with low-dose ASA and/or NSAIDs; contraindicated in patients receiving concomitant anticoagulants

Close surveillance of patients receiving co-medications

Renal excretion



~33% as active metabolite



Close surveillance of renal function and evaluation of drug choice/dose in patients with renal impairment