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Drug: Pradaxa
Therapy: Dialysis

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Total 73 results found since Jan 2013.

The acute management of haemorrhage, surgery and overdose in patients receiving dabigatran
Dabigatran is an oral direct thrombin inhibitor (DTI) licensed for stroke prevention in atrial fibrillation and likely to be soon approved in Europe for treatment of venous thrombosis. Predictable pharmacokinetics and a reduced risk of intracranial haemorrhage do not negate the potential risk of haemorrhage. Unlike warfarin, there is no reversal agent and measurement of the anticoagulant effect is not ‘routine’. The prothrombin time/international normalised ratio response to dabigatran is inconsistent and should not be measured when assessing a patient who is bleeding or needs emergency surgery. The activated p...
Source: Emergency Medicine Journal - January 15, 2014 Category: Emergency Medicine Authors: Alikhan, R., Rayment, R., Keeling, D., Baglin, T., Benson, G., Green, L., Marshall, S., Patel, R., Pavord, S., Rose, P., Tait, C. Tags: Poisoning/Injestion, Open access, Drugs: cardiovascular system, Stroke, Poisoning Review Source Type: research

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

Outcomes Associated with Apixaban Use in End-Stage Kidney Disease Patients with Atrial Fibrillation in the United States.
Conclusions -Among ESKD patients with AF on dialysis, apixaban use may be associated with lower risk of major bleeding compared with warfarin, with a standard 5 mg twice a day dose also associated with reductions in thromboembolic and mortality risk. PMID: 29954737 [PubMed - as supplied by publisher]
Source: Circulation - June 28, 2018 Category: Cardiology Authors: Siontis KC, Zhang X, Eckard A, Bhave N, Schaubel DE, He K, Tilea A, Stack AG, Balkrishnan R, Yao X, Noseworthy PA, Shah ND, Saran R, Nallamothu BK Tags: Circulation Source Type: research

Efficacy and Safety of Direct Oral Anticoagulants vs Warfarin in Patients with Chronic Kidney Disease and Dialysis Patients: A Systematic Review and Meta-Analysis
ConclusionsIn pooled, analyzed randomized controlled trials and observational studies, DOACs were associated with better efficacy in early CKD, as well as similar efficacy and safety outcomes to warfarin in patients with CKD stages 4 –5 or dialysis patients. The results of patients with CKD stages 4–5 and dialysis patients were from observational studies. Well-designed randomized controlled trials focused on DOAC use in patients with CKD and dialysis patients are needed.PROSPERO register number: CRD42020150599, 6 February, 2020.
Source: Clinical Drug Investigation - March 11, 2021 Category: Drugs & Pharmacology Source Type: research

Cardiovascular and renal outcomes in patients with atrial fibrillation and stage 4 –5 chronic kidney disease receiving direct oral anticoagulants: a multicenter retrospective cohort study
AbstractThe role of direct oral anticoagulants (DOAC) in patients with atrial fibrillation (AF) and stage 4 –5 chronic kidney disease (CKD) is controversial. Electronic medical records from 2012 to 2021 were retrieved for patients with AF and stage 4–5 CKD receiving oral anticoagulants. Patients were separated into those receiving DOACs (dabigatran, rivaroxaban, apixaban, or edoxaban) or vitamin K ant agonists (VKA). Primary outcomes included ischemic stroke (IS), systemic thrombosis (SE), major bleeding, gastrointestinal bleeding, hemorrhagic stroke, acute myocardial infarction, cardiovascular death, and all-cause dea...
Source: Journal of Thrombosis and Thrombolysis - August 21, 2023 Category: Hematology Source Type: research

The use of non-vitamin K oral anticoagulants in dialysis patients-A systematic review
This study investigated the available evidence for the use of NOACs in dialysis patients. Online databases were systematically searched for eligible studies including pharmacokinetic (PK) studies, cohort studies, and randomized control trials (RCTs) comparing NOAC with vitamin K antagonist (VKA) or no anticoagulant treatment. Newcastle Ottawa Scale and Cochrane Risk of bias tool were used for quality assessment. Twenty studies were identified (nine PK studies, two RCTs, and nine cohort studies). Most of the studies investigated apixaban or rivaroxaban. In dialysis patients, less accumulation was reported with apixaban and ...
Source: Seminars in Dialysis - May 27, 2022 Category: Urology & Nephrology Authors: Agitha Chandrasegaram Christian Daugaard Peters 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

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

Clinical Experience of Life-Threatening Dabigatran-Related Bleeding at a Large, Tertiary Care, Academic Medical Center: a Case Series.
CONCLUSION: Reversal strategies for dabigatran-related bleeding events at our institution are highly variable. Intracranial hemorrhage in patients on dabigatran was associated with 43 % mortality. Patients with severe dabigatran-related bleeding may benefit from a standardized approach to treatment. PMID: 24385325 [PubMed - as supplied by publisher]
Source: Journal of Medical Toxicology - January 3, 2014 Category: Toxicology Authors: Ross B, Miller MA, Ditch K, Tran M Tags: J Med Toxicol Source Type: research

Are we being told the whole truth about Pradaxa, the new 'wonder' stroke drug?
The anti-clotting effect of Pradaxa can't be reversed quickly. Emergency procedures such as blood transfusions or dialysis are needed.
Source: the Mail online | Health - May 20, 2014 Category: Consumer Health News Source Type: news

Management of Bleeding Complications in Patients Taking Direct Oral Anticoagulants at a Large Tertiary Academic Medical Center
Abstract Direct oral anticoagulants (DOACs) offer a fixed-dose alternative to warfarin for stroke prevention in patients with atrial fibrillation. However, there is minimal evidence to guide the management of bleeding in patients taking a DOAC. We retrospectively evaluated the acute management of major bleeding in this patient population at a large, tertiary academic medical center. We evaluated various strategies of management including dialysis, transfusions, pharmacologic agents, surgical intervention, and reinitiation of anticoagulation. We also assessed length of intensive care unit and hospital stay, mor...
Source: Current Emergency and Hospital Medicine Reports - June 13, 2015 Category: Emergency Medicine Source Type: research