Stroke and systemic thromboembolism remain critical causes of mortality and morbidity in patients with paroxysmal or persistent atrial fibrillation. Dabigatran etexilate is a novel oral direct thrombin inhibitor, which provides stroke risk reduction for patients with nonvalvular atrial fibrillation. Randomized clinical data demonstrate dabigatran to be an alternative oral anticoagulant with an improved efficacy profile compared with oral warfarin dose adjusted to an INR (international normalized ratio) target of 2.0 to 3.0.Our aim was to review the pharmacology, mechanism of action, drug metabolism, and clinical trial data supporting dabigatran use.We reviewed all the major published clinical studies of dabigatran and analyzed data regarding practical applications in selected clinical scenarios.This review provides recommendations for clinicians regarding dosing during invasive surgical procedures, transitioning off alternative anticoagulants, and a discussion of storage and handling of the drug.Our effort should facilitate the safe and effective use of dabigatran in atrial fibrillation.