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Pradaxa
dabigatran etexilate
Black Box Warnings .
Premature Tx Discontinuation
incr. thrombotic event risk when D/C dabigatran for reasons other than pathological bleeding or completion of therapy course; if must D/C dabigatran, consider administering another anticoagulant
Epidural/Spinal Hematoma Risk
epidural/spinal hematoma risk after neuraxial anesthesia or spinal puncture in anticoagulated pts; hematoma may result in long-term or permanent paralysis; incr. risk if indwelling epidural catheter use, concomitant use of drugs affecting hemostasis incl. NSAIDs, platelet inhibitors, or other anticoagulants, traumatic or repeated epidural or spinal puncture hx, spinal deformity or spinal surgery hx, unknown optimal timing between dabigatran admin. and neuraxial procedure; monitor s/sx neurologic impairment, treat urgently if needed; consider benefit vs. risk before neuraxial intervention in anticoagulated pts or planned anticoagulation
Adult Dosing .
Dosage forms: CAP: 75 mg, 110 mg, 150 mg
Special Note
- [formulation clarification]
- Info: dabigatran etexilate cap not interchangeable w/ dabigatran etexilate pellet; do not substitute on a mg to mg basis
thromboembolism/stroke prevention
- [150 mg PO bid]
- Info: for non-valvular atrial fibrillation w/o moderate-severe mitral stenosis or mechanical heart valve; to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 1-2 days before surgery or invasive procedure if CrCl >50 or 2-4 days if CrCl <50; resume tx >24h postop; do not open/dissolve cap
DVT/PE tx
- [150 mg PO bid]
- Start: after 5-10 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 1-2 days before surgery or invasive procedure if CrCl >50 or 2-4 days if CrCl <50; resume tx >24h postop; do not open/dissolve cap
DVT/PE prophylaxis, recurrent
- [150 mg PO bid]
- Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 1-2 days before surgery or invasive procedure if CrCl >50 or 2-4 days if CrCl <50; resume tx >24h postop; do not open/dissolve cap
DVT/PE prophylaxis, hip replacement
- [220 mg PO qd x28-35 days]
- Start: 110 mg PO x1 dose 1-4h postop or 220 mg PO qd on day after surgery; Info: do not open/dissolve cap
VTE prophylaxis, cardioversion (off-label)
- [afib/flutter duration <48h]
- Dose: 150 mg PO bid; Start: ASAP before or immediately after cardioversion; Info: for pts w/ CHA2DS2-VASc score >2; continue tx for at least 4wk after procedure; refer to ACC/AHA/HRS guidelines; do not open/dissolve cap
- [afib/flutter duration >48h or unknown]
- Dose: 150 mg PO bid; Start: at least 3wk before cardioversion; Info: continue tx for at least 4wk after procedure; refer to ACC/AHA/HRS guidelines; do not open/dissolve cap
renal dosing
- [thromboembolism/stroke prophylaxis]
- CrCl 15-30: 75 mg bid; CrCl <15: avoid use
- HD/PD: avoid use
- [VTE prophylaxis, cardioversion]
- renal impairment: not defined
- HD/PD: not defined
- [all other indications]
- CrCl >30: no adjustment; CrCl <30: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: CAP: 75 mg, 110 mg, 150 mg; PELLET: 20 mg per packet, 30 mg per packet, 40 mg per packet, 50 mg per packet, 110 mg per packet, 150 mg per packet
Special Note
- [formulation clarification]
- Info: dabigatran etexilate cap not interchangeable w/ dabigatran etexilate pellet; do not substitute on a mg to mg basis
venous thromboembolism tx
- [pellet form, 3-3.9 kg, 3-5 mo]
- Dose: 30 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 4-4.9 kg, 3-9 mo]
- Dose: 40 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 5-6.9 kg, 3-4 mo]
- Dose: 40 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 5-6.9 kg, 5-23 mo]
- Dose: 50 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 7-8.9 kg, 3 mo]
- Dose: 50 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 7-8.9 kg, 4-8 mo]
- Dose: 60 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 7-8.9 kg, 9-23 mo]
- Dose: 70 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 9-10.9 kg, 5 mo]
- Dose: 60 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 9-10.9 kg, 6-10 mo]
- Dose: 80 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 9-10.9 kg, 11-23 mo]
- Dose: 90 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 11-12.9 kg, 8-17 mo]
- Dose: 100 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 11-12.9 kg, 18-23 mo]
- Dose: 110 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 13-15.9 kg, 10 mo]
- Dose: 100 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 13-15.9 kg, 11-23 mo]
- Dose: 140 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 16-20.9 kg, 12-23 mo]
- Dose: 140 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 21-25.9 kg, 18-23 mo]
- Dose: 180 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 7-8.9 kg, 2-11 yo]
- Dose: 70 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 9-10.9 kg, 2-11 yo]
- Dose: 90 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 11-12.9 kg, 2-11 yo]
- Dose: 110 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 13-15.9 kg, 2-11 yo]
- Dose: 140 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 16-20.9 kg, 2-11 yo]
- Dose: 170 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 21-40.9 kg, 2-11 yo]
- Dose: 220 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, >41 kg, 2-11 yo]
- Dose: 260 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [capsule form, 11-15.9 kg, 8-17 yo]
- Dose: 75 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; do not open/dissolve cap
- [capsule form, 16-25.9 kg, 8-17 yo]
- Dose: 110 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; do not open/dissolve cap
- [capsule form, 26-40.9 kg, 8-17 yo]
- Dose: 150 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; do not open/dissolve cap
- [capsule form, 41-60.9 kg, 8-17 yo]
- Dose: 185 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; do not open/dissolve cap
- [capsule form, 61-80.9 kg, 8-17 yo]
- Dose: 220 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; do not open/dissolve cap
- [capsule form, >81 kg, 8-17 yo]
- Dose: 260 mg PO q12h; Start: after at least 5 days of parenteral anticoagulant tx; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; do not open/dissolve cap
venous thromboembolism prophylaxis, recurrent
- [pellet form, 3-3.9 kg, 3-5 mo]
- Dose: 30 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 4-4.9 kg, 3-9 mo]
- Dose: 40 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 5-6.9 kg, 3-4 mo]
- Dose: 40 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 5-6.9 kg, 5-23 mo]
- Dose: 50 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 7-8.9 kg, 3 mo]
- Dose: 50 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 7-8.9 kg, 4-8 mo]
- Dose: 60 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 7-8.9 kg, 9-23 mo]
- Dose: 70 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 9-10.9 kg, 5 mo]
- Dose: 60 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 9-10.9 kg, 6-10 mo]
- Dose: 80 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 9-10.9 kg, 11-23 mo]
- Dose: 90 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 11-12.9 kg, 8-17 mo]
- Dose: 100 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 11-12.9 kg, 18-23 mo]
- Dose: 110 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 13-15.9 kg, 10 mo]
- Dose: 100 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 13-15.9 kg, 11-23 mo]
- Dose: 140 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 16-20.9 kg, 12-23 mo]
- Dose: 140 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 21-25.9 kg, 18-23 mo]
- Dose: 180 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 7-8.9 kg, 2-11 yo]
- Dose: 70 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 9-10.9 kg, 2-11 yo]
- Dose: 90 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 11-12.9 kg, 2-11 yo]
- Dose: 110 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 13-15.9 kg, 2-11 yo]
- Dose: 140 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 16-20.9 kg, 2-11 yo]
- Dose: 170 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, 21-40.9 kg, 2-11 yo]
- Dose: 220 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [pellet form, >41 kg, 2-11 yo]
- Dose: 260 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; give before meals
- [capsule form, 11-15.9 kg, 8-17 yo]
- Dose: 75 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; do not open/dissolve cap
- [capsule form, 16-25.9 kg, 8-17 yo]
- Dose: 110 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; do not open/dissolve cap
- [capsule form, 26-40.9 kg, 8-17 yo]
- Dose: 150 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; do not open/dissolve cap
- [capsule form, 41-60.9 kg, 8-17 yo]
- Dose: 185 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; do not open/dissolve cap
- [capsule form, 61-80.9 kg, 8-17 yo]
- Dose: 220 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; do not open/dissolve cap
- [capsule form, >81 kg, 8-17 yo]
- Dose: 260 mg PO q12h; Info: to convert from UFH infusion, D/C UFH, then start dabigatran immediately; to convert from other parenteral anticoagulants, D/C parenteral anticoagulant, then start dabigatran 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start dabigatran when INR <2; to convert from other oral anticoagulants, D/C oral anticoagulant, then start dabigatran at next scheduled dose; depending on bleeding risk, consider holding tx 24h before surgery or invasive procedure if eGFR >80, or 2 days if eGFR 50-80; do not open/dissolve cap
renal dosing
- [see below]
- eGFR <50: avoid use
- HD/PD: not defined
hepatic dosing
- [not defined]