Abstract
Dabigatran etexilate is an oral, reversible direct thrombin inhibitor that has a predictable pharmacokinetic profile, allowing for a fixed-dose regimen without the need for routine coagulation monitoring. It has been recently approved for treatment of non valvular atrial fibrillation and as thromboemolic prophylaxis after orthopedic surgery. It's use as an alternative for Warfarin for other indications has not tested. We report two cases who had been successfully anticoagulated with Warfarin and had never experienced thrombotic or bleeding events. In both cases, one month after being switched from Coumadin to Dabigatran the patients began to experience symptoms and were subsequently diagnosed with mechanical valve thrombosis. Both cases underwent a succefull emergency redo valve replacement. The Use of novel anti-coagulants for unapproved indications can lead to serious and potentially fatal adverse events and represents an important public health concern.
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