Living with dabigatran
Find out more about diet and warfarin.
Alcohol can increase the risk of bleeding when taking anticoagulants — so it is best to limit your alcohol intake to no more than 2 standard drinks of alcohol per day and avoid binge drinking. (The Australian Government Department of Health explains what is meant by an Australian Standard Drink.) Ask your health professional for advice.
Warfarin is currently the anticoagulant most often used for preventing strokes in people with atrial fibrillation. Unlike warfarin, there is no equivalent of the INR blood test to monitor dabigatran’s effect on blood clotting, or to inform any dose changes.
Some people will prefer dabigatran as they won’t have to have ongoing blood tests. For others, the regular INR blood tests that are needed to monitor how well warfarin is working may be reassuring, since it is an easy way to tell if you are at risk of bleeding, and if a dose change is required.
Bleeding seems as likely to occur with dabigatran as it is with warfarin. However, unlike warfarin there is no specific antidote to dabigatran to stop the bleeding. So if you do have a serious bleed while you are taking dabigatran, it may take longer to treat.
If you are taking dabigatran you will still need to have regular check ups and blood tests to check your kidney function:
- before you start dabigatran
- at least once per year – especially if you are over 75 or have kidney problems
- if you get dehydrated or have any other problems that may affect your kidneys.
Discuss the advantages and disadvantages of dabigatran compared to other medicines (e.g. warfarin) with your doctor, and find out how dabigatran and warfarin compare.
Reduce the risk of bleeding
As with any anticoagulant medicine, dabigatran can cause serious bleeding. To reduce the risk you should:
- go to the emergency department of your nearest hospital if you have any prolonged or excessive bleeding, signs of internal bleeding (e.g. blood in your urine, or coughing up blood) or if you’ve hit your head
- report any falls to your doctor — even if there are no visible signs of bleeding — and discuss ways to reduce the risk of falls
- reducing your risk of injury — for example, by avoiding contact sports, wearing gloves when gardening, making adjustments around the home to reduce your risk of falls, using an electric shaver, brushing your teeth with a soft-bristled toothbrush
- consult your doctor or pharmacist before starting any new medicines, including vitamins or over-the-counter drugs, as these may interact with dabigatran
- tell all the health professionals involved in your care (including surgeons, dentists and naturopaths) that you are taking dabigatran - this will help to identify any potential interactions with other medicines
- let your health professional know that you are taking dabigatran before surgery or dental procedures, as they may need to temporarily suspend your treatment.
Find out more about:
- Rossi S, ed. eAMH [online]. Australian Medicines Handbook, January 2013. www.amh.net.au (accessed June 2013).
- Cardiovascular Expert Group. Therapeutic guidelines: cardiovascular. Therapeutic Guidelines Ltd; 2013. www.tg.org.au (accessed June 2013).
- NPS Medicine Update, April 2010. Dabigatran (Pradaxa) for preventing blood clots after hip or knee replacement surgery
- NPS Medicine Update, August 2011. Dabigatran (Pradaxa) for preventing stroke in people with atrial fibrillation