**5. Dabigatran (Pradaxa)**

#### **5.1 Mechanism of action**

Dabigatran prevents thrombus development through direct, competitive inhibition of thrombin (thrombin can convert fibrinogen to fibrin) and can inhibit free and clot-bound thrombin and thrombin-induced platelet aggregation [18, 19].

Dabigatran can be given when converting from warfarin when international normalized ratio (INR) is less than 2.0. It can also be used when converting from parenteral anticoagulant. In this case, give dabigatran 0–2 hours before next dose of parenteral drug.

When converting from dabigatran to warfarin, starting time of warfarin should be adjusted based on creatinine clearance.
