Dabigatran – skuteczny lek o potwierdzonej skuteczności i dobrym profilu bezpieczeństwa Artykuł przeglądowy
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Opublikowane:
mar 1, 2026
Słowa kluczowe:
leczenie przeciwkrzepliwe, DOAC, idarucyzumab, dabigatran, migotanie przedsionków
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Abstrakt
Dabigatran jest bezpośrednim inhibitorem trombiny o udowodnionej skuteczności w redukcji ryzyka zdarzeń zakrzepowo-zatorowych i – co ważne – mającym swoiste antidotum, jakim jest idarucyzumab. Niniejszy przegląd omawia kliniczne zastosowanie dabigatranu u pacjentów z migotaniem przedsionków, zwłaszcza z wywiadem udaru mózgu i niewydolnością wątroby, oraz u pacjentów po przezskórnej interwencji wieńcowej ze wskazaniem do leczenia przeciwkrzepliwego. Lek zapewnia unikatowe korzyści, ale wymaga starannego dostosowania dawki u pacjentów z przewlekłą chorobą nerek. W niniejszym opisie uwzględnione zostało praktyczne spojrzenie neurologa na stosowanie dabigatranu w prewencji wtórnej niedokrwiennego udaru mózgu oraz na ryzyko zdarzeń krwotocznych.
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Jak cytować
Skwarek, A., Golenia, A., & Ozierański, K. (2026). Dabigatran – skuteczny lek o potwierdzonej skuteczności i dobrym profilu bezpieczeństwa . Medycyna Faktów , 19(4(69), 527-532. https://doi.org/10.24292/01.MF.0425.07
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Bibliografia
1. Connolly SJ, Ezekowitz MD, Yusuf S et al. Dabigatran versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2009; 361(12): 1139-51.
2. Risks for Stroke, Bleeding, and Death in Patients With Atrial Fibrillation Receiving Dabigatran or Warfarin in Relation to the CHADS2 Score: A Subgroup Analysis of the RE-LY Trial. Ann Intern Med. 2011; 155(10): 660-7.
3. Panichpisal K, Szarek M, Sareen A. Dabigatran for stroke prevention in patients with atrial fibrillation and previous stroke or transient ischemic attack: does dose matter? Fut Neurol. 2011; 6: 155-8.
4. Liang M, Jin J, Zhao R et al. Dabigatran-based versus warfarin-based triple antithrombotic regimen with a 1-month intensification after coronary stenting in patients with nonvalvular atrial fibrillation (COACH-AF PCI). BMC Med. 2025; 23(1): 643.
5. Fischer U, Koga M, Strbian D et al.; ELAN Investigators. Early versus Later Anticoagulation for Stroke with Atrial Fibrillation. N Engl J Med. 2023; 388(26): 2411-21.
6. Oldgren J, Åsberg S, Hijazi Z et al.; National TIMING Collaborators. Early Versus Delayed Non-Vitamin K Antagonist Oral Anticoagulant Therapy After Acute Ischemic Stroke in Atrial Fibrillation (TIMING): A Registry-Based Randomized Controlled Noninferiority Study. Circulation. 2022; 146(14): 1056-66.
7. Cannon CP, Bhatt DL, Oldgren J et al. Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation. N Engl J Med. 2017; 377(16): 1513-24.
8. Vrints C, Andreotti F, Koskinas KC et al. 2024 ESC Guidelines for the management of chronic coronary syndromes: Developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024; 45(36): 3415-537.
9. Pollack CV, Reilly PA, van Ryn J et al. Idarucizumab for Dabigatran Reversal – Full Cohort Analysis. N Engl J Med. 2017; 377(5): 431-41.
10. van der Wall SJ, van Rein N, van den Bemt BJF et al. Performance of idarucizumab as antidote of dabigatran in daily clinical practice. EP Europace. 2018; 21: 414-20.
11. Violi F, Vestri A, Menichelli D et al. Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Advanced Liver Disease: An Exploratory Meta‐Analysis. Hepatology Communications. 2020; 4: 1034-40.
12. Khalid A, Mautong H, Hasnol H et al. S1589 Risks and Benefits of DOACS vs Warfarin in Patients With AF and Liver Disease – A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2023; 118: S1201-2.
13. Lee S-R, Lee H-J, Choi EK et al. Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Liver Disease. J Am Coll Cardiol. 2019; 73 25: 3295-308.
14. Elhosseiny S, Al Moussawi H, Chalhoub JM et al. Direct Oral Anticoagulants in Cirrhotic Patients: Current Evidence and Clinical Observations. Can J Gastroenterol Hepatol. 2019; 2019: 4383269.
15. European Medicines Agency (EMA). Charakterystyka Produktu Medycznego Pradaxa (dabigatran etexilate).
2. Risks for Stroke, Bleeding, and Death in Patients With Atrial Fibrillation Receiving Dabigatran or Warfarin in Relation to the CHADS2 Score: A Subgroup Analysis of the RE-LY Trial. Ann Intern Med. 2011; 155(10): 660-7.
3. Panichpisal K, Szarek M, Sareen A. Dabigatran for stroke prevention in patients with atrial fibrillation and previous stroke or transient ischemic attack: does dose matter? Fut Neurol. 2011; 6: 155-8.
4. Liang M, Jin J, Zhao R et al. Dabigatran-based versus warfarin-based triple antithrombotic regimen with a 1-month intensification after coronary stenting in patients with nonvalvular atrial fibrillation (COACH-AF PCI). BMC Med. 2025; 23(1): 643.
5. Fischer U, Koga M, Strbian D et al.; ELAN Investigators. Early versus Later Anticoagulation for Stroke with Atrial Fibrillation. N Engl J Med. 2023; 388(26): 2411-21.
6. Oldgren J, Åsberg S, Hijazi Z et al.; National TIMING Collaborators. Early Versus Delayed Non-Vitamin K Antagonist Oral Anticoagulant Therapy After Acute Ischemic Stroke in Atrial Fibrillation (TIMING): A Registry-Based Randomized Controlled Noninferiority Study. Circulation. 2022; 146(14): 1056-66.
7. Cannon CP, Bhatt DL, Oldgren J et al. Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation. N Engl J Med. 2017; 377(16): 1513-24.
8. Vrints C, Andreotti F, Koskinas KC et al. 2024 ESC Guidelines for the management of chronic coronary syndromes: Developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024; 45(36): 3415-537.
9. Pollack CV, Reilly PA, van Ryn J et al. Idarucizumab for Dabigatran Reversal – Full Cohort Analysis. N Engl J Med. 2017; 377(5): 431-41.
10. van der Wall SJ, van Rein N, van den Bemt BJF et al. Performance of idarucizumab as antidote of dabigatran in daily clinical practice. EP Europace. 2018; 21: 414-20.
11. Violi F, Vestri A, Menichelli D et al. Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Advanced Liver Disease: An Exploratory Meta‐Analysis. Hepatology Communications. 2020; 4: 1034-40.
12. Khalid A, Mautong H, Hasnol H et al. S1589 Risks and Benefits of DOACS vs Warfarin in Patients With AF and Liver Disease – A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2023; 118: S1201-2.
13. Lee S-R, Lee H-J, Choi EK et al. Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Liver Disease. J Am Coll Cardiol. 2019; 73 25: 3295-308.
14. Elhosseiny S, Al Moussawi H, Chalhoub JM et al. Direct Oral Anticoagulants in Cirrhotic Patients: Current Evidence and Clinical Observations. Can J Gastroenterol Hepatol. 2019; 2019: 4383269.
15. European Medicines Agency (EMA). Charakterystyka Produktu Medycznego Pradaxa (dabigatran etexilate).