Table 1 An audit checklist for dabigatran prescription

Indication

• Prevention of strokes and systemic thromboembolic complications in patients with non-valvular atrial fibrillation

Contraindications

• Severe renal dysfunction (CLcr < 30 mL/min or eGFR < 30 mL/min/1.73 m^2a)

• Active bleeding or hemorrhagic diathesis

• Clinical complications associated with high-risk of bleeding (cerebral hemorrhage) within 6 months

• Concomitant indwelling of spinal or epidural catheter

• Concomitant oral administration of itraconazole

• History of serious hypersensitivity reaction to Prazaxa®

Instruction of dose reduction (300 mg/day to 220 mg/day)

• Moderate renal dysfunction (CLcr 30–50 mL/min or eGFR 30–50 mL/min/1.73 m^2a)

• Concomitant oral administration of P-glycoprotein inhibitors^b

• Age ≥ 70 years

• Previous history of gastrointestinal bleeding

Instruction for timing of initiating dabigatran therapy after withdrawal of warfarin

• Dabigatran should be started after PT-INR decreases < 2.0