9th March 2018, Volume 131 Number 1471

Lynn McBain, Anna Kyle

Dabigatran, a reversible thrombin inhibitor and novel oral anticoagulant (NOAC) became fully funded in New Zealand in 2011. The Best Practice Advocacy Centre New Zealand (bpacnz) published prescriber information on…

Subscriber content

The full contents of this page is only available to subscribers.

To view this content please login or subscribe


The Compass Health Primary Health Organisation checked every patient prescribed the anticoagulant (blood thinner) dabigatran twice during 2014 and 2016. There was a big increase in patients prescribed dabigatran during this time. Kidney function needs to be monitored if dabigatran is being taken. Ninety-six (96%) percent of patients prescribed dabigatran were taking it for approved reasons and 90% of patients had their kidney function checked each year, which is recommended by treatment guidelines.



To assess annual renal function monitoring and clinical indications for use in patients prescribed dabigatran.


A quality improvement activity included all patients in the Compass Health Primary Health Organisation (PHO) prescribed dabigatran. Information recorded: demographics; indication for use; daily dose; height; weight; serum creatinine; and estimated glomerular filtration rate (eGFR). The first audit occurred during July 2013 – May 2014, the second during May 2014 – October 2016.


Across the PHO, all patients prescribed dabigatran were reviewed: 941 patients and 1,564 respectively. At the time of the second pass audit, renal function monitoring improved from 88% to 90%, and 96% were prescribed dabigatran for an approved indication.


Results showed a continuing high level of renal function monitoring across the PHO in 90% of patients prescribed dabigatran. Practitioners were reminded to use creatinine clearance as a marker of renal function. Dabigatran was prescribed for an approved indication in 96% of patients. Our results are in line with recommended best practice and clinical guidelines.

Author Information

Lynn McBain, General Practitioner Brooklyn Medical Centre, Wellington; Senior Lecturer, Primary Health Care & General Practice, University of Otago, Wellington;
Anna Kyle, Clinical Advisory Pharmacist, Compass Health, Wellington.


We would like to acknowledge the participation, data collection and commitment of Practice personnel at all levels in both audits as well as the PHO pharmacists, Marilyn Tucker and Hilary Krebs. Compass Health PHO acknowledges and thanks Bpac for allowing us to
use a modified version of their audit “Renal function testing in people taking dabigatran”.


Anna Kyle, Compass Health, PO Box 27 380, Marion Square, Wellington.

Correspondence Email


Competing Interests

AK and LM are employed at Compass Health PHO; Dr McBain is a practicing general practitioner, there are patients included in the audit who are enrolled at Dr McBain's practice.


  1. Burgess C, Devlin G, Fink J, et al. The use of dabigatran in general practice. BPJ. 2011 September; 38:10–27. Accessed 2017 February 21. http://www.bpac.org.nz/BPJ/2011/september/dabigatran.aspx
  2. Boehringer Ingelheim (NZ) Ltd. Dabigatran etexilate (Pradaxa NZ DS v03). Medicine data sheet. Medsafe. Accessed 2017 September 20. http://www.medsafe.govt.nz/profs/Datasheet/p/Pradaxacap.pdf
  3. Best Practice Advocacy Centre (Bpac). Dabigatran - an update. Bpac Report. 2015 March. Accessed 2017 September 20. http://www.bpac.org.nz/Report/2015/March/dabigatran.aspx
  4. Medsafe. Monitor renal function in elderly patients taking dabigatran. Prescriber Update. 2015 December; 36(4):55. 
  5. Willett K, Morrill A. Use of direct oral anticoagulants for the prevention and treatment of thromboembolic disease in patients with reduced renal function: a short review of the clinical evidence. Ther Clin Risk Manag. 2017 Apr 6; 13:447–454. 
  6. Ailings M. Individualising anticoagulant therapy in atrial fibrillation patients. Arrhythm Electrophysiol Rev. 2016 Aug; 5(2):102–109.
  7. Bell S, Nand J, Spriggs D, et al. Initial experience with dabigatran etexilate at Auckland City Hospital. N Z Med J. 2012 February 10; 125(1349):105–107.
  8. Duffull S, Wright D, Al-Sallami H, et al. Dabigatran: rational dose individualisation and monitoring guidance is needed. N Z Med J. 2012 Jun 29; 125(1357):148–154.
  9. Metcalfe S, Moodie P. National prescribing data for dabigatran. N Z Med J. 2012 Mar 9; 125(1351):97–105.
  10. Steinberg B, Shrader P, Thomas L, et al. Off-label dosing of non-vitamin K antagonist oral anticoagulants and adverse outcomes: The ORBIT-AF II registry. J Am Col Cardiol 2016 Dec20; 68(24):2597–2604.
  11. Best Practice Advocacy Centre (Bpac). Report: Dabigatran monitoring, an update. Accessed 2017 October 5. http://www.bpac.org.nz/report/2017/september/dabigatran.aspx
  12. Best Practice Advocacy Centre (Bpac). Renal function testing in people taking dabigatran. Clinical Audit (valid until December 2017). Accessed 2017 September 20. http://www.bpac.org.nz/Audits/Dabigatran-renal.aspx
  13. Molteni M, Bo M, Di Minno G, et al. Dabigatran etexilate: appropriate use in patients with chronic kidney disease and in the elderly patients. Intern Emerg Med. 2017 Jun; 12(4):425–435. 
  14. Thorne K, Dee S, Jayathissa S. Prescriber compliance with renal function monitoring in patients taking dabigatran (Pradaxa). New Zealand Medical Journal. 2015 December; 128(1426):83–87.
  15. Howey O, Chin P. Usage of renal function equations to guide prescribing in general medicine. N Z Med J. 2013 September 27; 126(1383):97–98.
  16. New Zealand Formulary. Dabigatran etexilate. New Zealand Formulary NZF v64 – 01. October 2017. Accessed 2017 October 5. http://nzf.org.nz/nzf_1504
  17. Walker R, Voss D. Mate tākihi ukiuki. Making a difference in chronic kidney disease Part 1: catching renal impairment early. Best Practice Journal (BPJ). 2009 July; 22:24–29.


The downloadable PDF version of this article is only available to subscribers.

To view this content please login or subscribe