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The lower dose purely applies to elderly patients – apart from that it really is supposed to be ‘one dose suits all’, as the results of the trials suggest only the 150mg BD to be ‘not inferior’ to warfarin. There is no need for regular testing -that is supposed to be the major plus point. The degree of anticoagulation achieved by the direct thrombin inhibitors and the factor X antagonists does not correlate with INR although treatment with the newer drugs can cause a raised INR in some patients. Partial thromboplastin time gives some idea of the level of anticoagulation, for use in an emergency situation, but is not appropriate, or required, for general use. The frequency of monitoring has not (yet) been stipulated but it seems likely that compliance checking will be critical, as will occasional monitoring of renal and liver function. Robert From: GP-UK [mailto:[log in to unmask]] On Behalf Of Roger Gardiner the idea that 'one dose fits all' for dabigatran no longer applies so how often do they say we should test? or is it an age related dose with fingers crossed? -----Original Message----- From: Robert Treharne Jones <[log in to unmask]> You won't be surprised to hear that we have done (more than one) analysis over the past many months, and it has become apparent throughout that the cost of the new drugs was always going to be more expensive than the cost of the entire warfarin monitoring service unless the price of dabigatran was set significantly lower than its current level. Clinicians are however being encouraged to 'think beyond the pricing issues' when considering prescribing dabigatran. I suspect that 'time in therapeutic range' on warfarin will prove to be one of the key factors when deciding who might benefit most from a change in prescription. -----Original Message----- From: GP-UK [mailto:[log in to unmask] <mailto:[log in to unmask]> ] On Behalf Of Chris Markwick We are surgery that does in house anticoagulation monitoring.Has anyone done a practice cost analysis to see if its cheaper to switch to dabigatran & free up the nurses time to do other things? Currently prescribing isnt a real budget per se but its something the PCT keeps an eye on whereas staff costs are real.