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Dabigatran overdose: case report of laboratory coagulation parameters and hemodialysis of an 85-year-old man.
Blood Coagul Fibrinolysis ; 26(2): 225-9, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25629417
ABSTRACT
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 assay (ECA) and diluted thrombin time (dTT)] laboratory coagulation tests in patients receiving dabigatran with untoward effects, we describe a case in which hemodialysis was used in attempt to remove dabigatran in a patient with excessive anticoagulation, rectal bleeding, and severe anemia. Our experience confirmed that APTT is an unreliable method for the assessment of dabigatran in patients with acute complications because it was often normal in spite of the therapeutic drug plasma levels. Both ECA and dTT showed a linear correlation with dabigatran levels over a broad range, and identified therapeutic and supratherapeutic levels. TT assay, which is highly sensitive to dabigatran, correlated well and linearly not only with low drug levels, but also, because of the introduction of the extended endpoint (400 s), with high concentrations of the drug, and demonstrated to be a simple and reliable alternative to ECA and dTT to assess dabigatran in patients with acute complications.
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Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Assunto principal: Benzimidazóis / Coagulação Sanguínea / Antitrombinas / Diálise Renal / Beta-Alanina / Overdose de Drogas Tipo de estudo: Relato de casos / Primary_study Limite: Humanos / Masculino Idioma: Inglês Revista: Blood Coagul Fibrinolysis Assunto da revista: Angiologia / Hematologia Ano de publicação: 2015 Tipo de documento: Artigo País de afiliação: Itália