DOAC At-a-Glance Reference updated: August 2018

DOAC At-a-Glance Reference updated: August 2018 DOAC_At-a-Glance_8-27-2018 MGH Anticoagulation Management Service file owner: L B Oertel Page 1 of 4 Dabigatran PI March 2018 Indication Dose Modifiers Renal Hepatic Impairment Child-Pugh Class: Pregnancy Reversal Lactation DABIGATRAN Halflife: 12-17h Tmax: 1-2h NVAF CrCl>30mL/min 150mg twice daily AVOID P-gp inducer rifampin *dronedarone or ketoconazole HD: Avoid B: large inter-subject variability. No evidence of consistent change in exposure or pharmacodynamics May increase risk of bleeding in fetus and neonate For life threatening emergencies or urgent surgery: idarucizumab (Praxbind ) IV in 2 divided doses Hemodialysis can remove CrCl 15-30 mL/min 75 mg twice daily CrCl <15 or HD No recommendation CrCl 30-50 AND P-gp inhib* 75 mg twice daily CrCl 15-30 AND P-gp inhib* AVOID VTE CrCl >30 mL/min 150mg twice daily AFTER 5-10 (7 MGH AMS) day lead-in with parenteral agent CrCl 30 or HD No recommendation Breastfeeding NOT recommended CrCl <50 and P-gp inhibitor AVOID VTE risk reduction CrCl >30mL/min 150 mg twice daily CrCl 30 or HD No recommendation CrCl<50 and P-gp inhibitor

erythromycin) avoided . P. reduction. Halflife: 5-9h . Tmax: 2-4h. NVAF . CrCl>50 mL/min 20mg daily with food AVOID concomitant P-gp and strong CYP3A4 inhibitors (ketoconazole,

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