*CCS Guidelines recommend 150 mg BID as the usual daily dose for dabigatran for the prevention of stroke in AF.

In the RELY Trial, the benefit of 150 mg BID over 110 mg BID of dabigatran was preserved across ranges of age, sex, and renal function. The risk of bleeding, however, did increase with age (Eikelboom JW et al. Circulation. 2011 May 31;123(21):2363-72).

The Canadian Product Monograph recommends 150 mg BID as the standard maintenance dose for most patients with an estimated creatinine clearance greater than 30 ml/min; for patients over the age of 80, 110 mg BID may be considered, as well as in patients over the age of 75 with at least one risk factor for bleeding.

It is reasonable to consider the lower dose of dabigatran in patients over the age of 80, or over the age of 75 with an estimated creatinine clearance in the range of 30-50 mL/min, or the administration of drugs that are substrates for the PgP transporter, such as amiodarone, dronedarone, diltiazem , or verapamil (ketoconazole is contraindicated in combination with dabigatran) , particularly if there are additional risk factors for bleeding (e.g. hypertension, prior bleeds, frailty, liver disease, etc).

Some authorities feel that the benefits of 150 mg BID over 110 mg BID are preserved for all patient sub groups, and that this dose should be used for all patients with a creatinine clearance over 30 mL/min. (Beasley BN et al. N Engl J Med. 2011 May 12;364(19):1788-90). Patients with an increased risk of bleeding, especially the elderly and those with renal dysfunction, should be closely monitored for signs of overt or occult bleeding."