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Quick Question Summary: Monitoring Dabigatran

Here is a summary of our July, 2011 Quick Question:

Now that dabigatran (Pradaxa), the new oral direct thrombin inhibitor, is available, how do you intend to monitor it?

a. Ecarin clotting time: 7 (13%)
b. We will not monitor Pradaxa: 18 (32%)
c. Partial thromboplastin time: 12 (21%)
d. Stago Ecarin chromogenic assay: 7 (13%)
e. BIOPHEN Hemoclot thrombin inhibitor assay: 12 (21%)

Given that dabigatran was FDA-clearedonly  in October, 2010, it looks like a lot of us in the US have already put some thought into monitoring. I’ve received a number of comments about dabigatran on Fritsma Factor, and have heard a number of anecdotes about requests from emergency departments, so I suspect that of the 18 who responded they will not monitor, some are likely to change their minds

Given the information published in the review, Samama MM, Guinet C. Laboratory assessment of new anticoagulants. Clin Chem Lab Med 2011;49: 761–72, I doubt anyone will stick with the PTT after Stago, BIOPHEN, and others have gotten their DTI assays through the FDA process. It appears the various PTT reagent/coagulometer combinations are too variable to monitor dabigatran long-term, whereas the Ecarin- and thrombin-based clotting times (and chromogenics) claim to be linear. Geo.

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