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Maybe Pradaxa (dabigatran) does need blood monitoring after all
2.5 out of 5 stars The Effect of Dabigatran Plasma Concentrations and Patient Characteristics on the Frequency of Ischemic Stroke and Major Bleeding in Atrial Fibrillation Patients. Reilly PA et al. J Am Coll Cardiol 2014 Feb 4;63:321-8. Abstract A must-read article in yesterday’s New York Times described the internal battle at Boehringer Ingelheim, the maker of Pradaxa (dabiagtran etexilate), concerning the publication of this study. A major marketing point posited in favor of dabigatran over warfarin for the prevention of stroke in patients with atrial fibrillation was that it did not require monitoring with reg...
Source: The Poison Review - February 7, 2014 Category: Toxicology Authors: Leon Tags: Medical bleeding blood testing boehringer ingelheim dabigatran pradaxa stroke Source Type: news

Can I use DOAC in a patient with renal disease?
Case A 76-year-old man is diagnosed with non-valvular atrial fibrillation. His comorbid conditions are hypertension, diabetes complicated by neuropathy, and chronic kidney disease stage 3. His current medications include metformin, lisinopril, gabapentin, and aspirin. His most recent laboratories showed a creatinine 1.8, creatinine clearance (CrCl) 35 mL/min, hemoglobin 11g/dL, and international normalized ratio 1.0. His congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and sex (CHADSVASc) score is 4. Which medication should we use to prevent stroke in this patient?  Brief overview of the is...
Source: The Hospitalist - February 3, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Renal & Genitourinary Source Type: research

Anti ‐thrombotic therapy for atrial fibrillation in patients with chronic kidney disease: Current views
Abstract Chronic kidney disease (CKD) occurs in approximately one‐third of patients with non‐valvular atrial fibrillation (AF). The presence of CKD, particularly advanced CKD, confers increased risk of both thromboembolism and major bleeding in this group of patients who are already at risk for ischemic stroke and systemic embolism and at risk of bleeding due to anticoagulation. Studies assessing the effect of warfarin on risk of ischemic stroke, systemic embolism, and major bleeding have produced disparate results, particularly in patients with advanced CKD including those treated with hemodialysis. The direct oral an...
Source: Hemodialysis International - October 24, 2017 Category: Hematology Authors: Rugheed Ghadban, Greg Flaker, Natraj Katta, Martin A. Alpert Tags: REVIEW ARTICLE Source Type: research

Perioperative management and therapy of bleeding complications.
Abstract The new oral anticoagulants directly inhibit either thrombin (Dabigatran, Pradaxa®,) or activated Factor X (rivaroxaban, Xarelto®, and apixaban, Eliquis®) and have been approved for thromboprophylaxis after hip and knee replacement surgery and stroke prevention in non-valvular atrial fibrillation. Moreover, rivaroxaban has been approved for the treatment of deep venous thrombosis, prevention of pulmonary embolism and anticoagulation after acute myocardial infarction. The direct FXa-inhibitor edoxaban (Lixiana®) expects approval for the prevention of stroke in atrial fibrillation in Germany in 2014. Th...
Source: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS - March 1, 2014 Category: Intensive Care Authors: von Heymann C, Kaufner L, Körber M Tags: Anasthesiol Intensivmed Notfallmed Schmerzther Source Type: research

Dabigatran and Rivaroxaban Use in Atrial Fibrillation Patients on Hemodialysis.
CONCLUSIONS: -More dialysis patients are being started on dabigatran and rivaroxaban, even when their use is contraindicated and there are no studies to support the benefits outweigh the risks of these drugs in ESRD. PMID: 25595139 [PubMed - as supplied by publisher]
Source: Circulation - January 16, 2015 Category: Cardiology Authors: Chan KE, Edelman ER, Wenger JB, Thadhani RI, Maddux FW Tags: Circulation Source Type: research

Case report: hemodialysis for dabigatran overdose
3 out of 5 stars Hemodialysis for the Treatment of Pulmonary Hemorrhage from Dabigatran Overdose. Chen BC et al. Am J Kidney Dis 2013 Apr 15 [Epub ahead of print] Abstract Dabigatran (Pradaxa) is a competitive direct thrombin inhibitor approved in the United States for stroke prophylaxis in patients with nonvalvular atrial fibrillation. Although dabigatran has certain advantages over coumadin related to issues of dosing and testing, there is no readily available test to measure its anticoagulation effect, and there is no antidote to reverse bleeding. Recommendations for treating a patient with dabigatran-associated hemorr...
Source: The Poison Review - April 24, 2013 Category: Toxicology Authors: Leon Tags: Medical dabigatran hemodialysis hemorrhage overdose Source Type: news

Managing New Oral Anticoagulants in the Perioperative and Intensive Care Unit Setting
Managing patients in the perioperative setting receiving novel oral anticoagulation agents for thromboprophylaxis or stroke prevention with atrial fibrillation is an important consideration for clinicians. The novel oral anticoagulation agents include direct Factor Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran. In elective surgery, discontinuing their use is important, but renal function must also be considered because elimination is highly dependent on renal elimination. If bleeding occurs in patients who have received these agents, common principles of bleeding management as with an...
Source: Anesthesiology - April 23, 2013 Category: Anesthesiology Tags: Education: Review Article Source Type: research

Extracorporeal Therapy for Dabigatran Removal in the Treatment of Acute Bleeding: A Single Center Experience.
CONCLUSIONS: Extracorporeal therapy lowered dabigatran concentrations, suggesting that it removed the drug and may effectively accelerate total clearance, especially in patients with impaired kidney function. The use of prolonged intermittent hemodialysis or intermittent hemodialysis followed by continuous renal replacement therapy is recommended for the management of life-threatening bleeding in patients receiving dabigatran. The advantage of extracorporeal therapy should be weighed against the risk of bleeding with catheter insertion. PMID: 23704302 [PubMed - as supplied by publisher]
Source: Clinical Journal of the American Society of Nephrology : CJASN - May 23, 2013 Category: Urology & Nephrology Authors: Singh T, Maw TT, Henry BL, Pastor-Soler NM, Unruh ML, Hallows KR, Nolin TD Tags: Clin J Am Soc Nephrol Source Type: research

Treatment of Dabigatran-Associated Bleeding: Case Report and Review of the Literature
We report a case involving an 84-year-old male with acute kidney injury who developed life-threatening gastrointestinal and surgical site bleeding secondary to dabigatran accumulation. Use of the Naranjo probability scale indicated a probable cause between the bleeding event and dabigatran use. After discontinuation of drug therapy, fresh frozen plasma, recombinant coagulation factor VIIa, and cryoprecipitate were administered as potential reversal agents with negligible benefit. However, this patient appeared to slowly benefit with administration of continuous venovenous hemodialysis. Based upon our experience with this p...
Source: Journal of Pharmacy Practice - June 5, 2013 Category: Drugs & Pharmacology Authors: Harinstein, L. M., Morgan, J. W., Russo, N. Tags: Adverse Drug Events Source Type: research

Review of Recently Approved Alternatives to Anticoagulation with Warfarin for Emergency Clinicians
Conclusion: There is a need for assays for the degree of anticoagulation produced by drugs such as dabigatran and rivaroxaban. Additionally, studies are needed to evaluate reversal agents that could be effective in the setting of acute bleeding.
Source: The Journal of Emergency Medicine - February 1, 2013 Category: Emergency Medicine Authors: Elizabeth Brem, Alex Koyfman, Mark Foran Tags: Clinical Reviews Source Type: research

Patient with acute renal injury presenting dabigatran overdose: Hemodialysis for surgery.
We report a case of an 80-year-old man presenting hemorrhage with dabigatran overdose caused by obstructive acute renal failure. Before nephrostomy, several hemodialysis sessions were necessary to remove dabigatran probably because of its large volume of distribution. PMID: 24378048 [PubMed - as supplied by publisher]
Source: Annales Francaises d'Anesthesie et de Reanimation - December 27, 2013 Category: Anesthesiology Authors: Bachellerie B, Ruiz S, Conil JM, Crognier L, Seguin T, Georges B, Fourcade O Tags: Ann Fr Anesth Reanim Source Type: research

Perioperative management of patients on new oral anticoagulants
ConclusionManagement of NOACs in elective and emergency conditions requires knowledge of time of last intake of drug, current renal function and the planned procedure in order to assess the overall risk of bleeding. Currently no antidote exists to reverse the effects of these drugs.
Source: British Journal of Surgery - April 29, 2014 Category: Surgery Authors: A. Lai, N. Davidson, S. W. Galloway, J. Thachil Tags: Review Source Type: research

Dabigatran overdose: case report of laboratory coagulation parameters and hemodialysis of an 85-year-old man
Dabigatran is an oral direct inhibitor indicated for stroke prevention in patients with atrial fibrillation. Unlike warfarin, dabigatran's observed therapeutic window and minimal drug-to-drug interaction suggest that laboratory test and dose adjustments are not necessary; nevertheless, circumstances of excessive anticoagulation, decreased kidney function, and instances of significant bleeding and thrombosis require laboratory assessment. In order to gather experience in the management of global [activated partial thromboplastin time (APTT) and thrombin time (TT) with extended endpoint] and specific [ecarin chromogenic assa...
Source: Blood Coagulation and Fibrinolysis - January 30, 2015 Category: Hematology Tags: Case Reports Source Type: research

Management of dabigatran-induced bleeding with continuous venovenous hemodialysis.
Abstract Dabigatran, a direct thrombin inhibitor, is increasingly used for stroke prevention in patients with non-valvular atrial fibrillation. Dabigatran has a stable pharmacokinetic profile with minimum drug interactions, and requires no routine laboratory evaluation to measure level of anticoagulation. This provides a huge advantage over warfarin, and has the potential to improve patient compliance. The disadvantages of dabigatran are the lack of a reversal agent to counter dabigatran-related bleeding and the absence of a widely available laboratory test that can quantify the extent of coagulopathy in dabigatr...
Source: International Journal of Hematology - January 30, 2015 Category: Hematology Authors: Paul S, Hamouda D, Prashar R, Mbaso C, Khan A, Ali A, Shah S, Assaly R Tags: Int J Hematol Source Type: research

Hemodialysis for the treatment of dabigatran‐associated bleeding: a case report and systematic review
ConclusionsIn patients with dabigatran associated bleeding, RRT appears to be effective in reducing dabigatran concentrations and in case reports this has been associated with a reduction in duration and/or severity of bleeding. However, a rebound in concentrations may be seen following withdrawal of RRT suggesting that a prolonged course of RRT may be more effective.This article is protected by copyright. All rights reserved.
Source: Journal of Thrombosis and Haemostasis - August 1, 2015 Category: Hematology Authors: Chatree Chai‐Adisaksopha, Christopher Hillis, Wendy Lim, Kochawan Boonyawat, Karen Moffat, Mark Crowther Tags: Original Article ‐ Clinical Haemostasis and Thrombosis Source Type: research

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