Dabigatran: A Cause of Hematologic Emergency

Lal, Yasir; Heukelom, Joel Van

doi:10.1097/maj.0b013e31826c5a56

Cited by 17 publications

(9 citation statements)

References 22 publications

(12 reference statements)

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“…There have been a number of case studies showing serious bleeding events associated with dabigatran use 59 60. However, in phase III studies, 30-day mortality after the first major bleeding event tended to be lower with dabigatran (9.1%) than with warfarin (13.0%; p=0.057) 61.…”

Section: Practical Aspects Of Oral Anticoagulant Therapymentioning

confidence: 99%

Direct oral anticoagulants: integration into clinical practice

Cowell¹

2014

Postgraduate Medical Journal

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The introduction of direct oral anticoagulants (OACs) for the treatment and prevention of thromboembolic disease represents a shift from the traditional vitamin K antagonist-based therapies, which have been the mainstay of treatment for almost 60 years. A challenge for hospital formularies will be to manage the use of direct OACs from hospital to outpatient settings. Three direct OACs—apixaban, dabigatran and rivaroxaban—are widely approved across different indications, with rivaroxaban approved across the widest breadth of indications. A fourth direct OAC, edoxaban, has also completed phase III trials. Implementation of these agents by physicians will require an understanding of the efficacy and safety profile of these drugs, as well as an awareness of renal function, comedication use, patient adherence and compliance. Optimal implementation of direct OACs in the hospital setting will provide improved patient outcomes when compared with traditional anticoagulants and will simplify the treatment and prevention of thromboembolic diseases.

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Section: Practical Aspects Of Oral Anticoagulant Therapymentioning

confidence: 99%

Direct oral anticoagulants: integration into clinical practice

Cowell¹

2014

Postgraduate Medical Journal

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“…30,49 Case reports and series describe HD use for dabigatran removal in patients with hemorrhagic stroke. 13,15,16,50 Because of the risk of early hematoma expansion in intraparenchymal hemorrhage, the viability of HD may be limited by the risk of obtaining vascular access in an anticoagulated patient, delayed availability of HD, and duration of HD. Despite these limitations, our institutional guidelines recommend HD before the use of factor products and FFP due to the lack of proven efficacy and safety concerns associated with these agents.…”

Section: Management Of Dabigatran-associated Intracranial Hemorrhagementioning

confidence: 99%

“…[11][12][13][14][15][16][17] Consequently, FDA investigated actual rates of hemorrhage in new dabigatran users versus new warfarin users using insurance claims and administrative data. The investigation found similar rates of gastrointestinal and intracranial hemorrhage between the groups.…”

mentioning

confidence: 99%

Dabigatran-Associated Intracranial Hemorrhage

King

Szarlej

Rincón

2015

The Neurohospitalist

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Dabigatran etexilate is an oral direct thrombin inhibitor approved for prevention of stroke and systemic embolization in patients with nonvalvular atrial fibrillation and for the treatment of venous thromboembolism. Although dabigatran has a favorable safety profile, predictable pharmacokinetics, fewer drug interactions than warfarin, and does not require monitoring, clinical data regarding dabigatran reversal are limited. In addition, currently available laboratory assays allow measurement of the presence, but not extent, of dabigatran-associated anticoagulation. Patient age, renal function, weight, concurrent drug therapy, adherence, and concomitant disease states can affect dabigatran's efficacy and safety. Management of dabigatran-related intracranial hemorrhage must be approached on a case-by-case basis and include assessment of degree of anticoagulation, severity of hemorrhage, renal function, timing of last dabigatran dose, and risk of thromboembolic events. Initial management includes dabigatran discontinuation and general supportive measures. Oral activated charcoal should be administered in those who ingested dabigatran within 2 hours. Four-factor prothrombin complex concentrates (4PCCs), activated PCC, or recombinant activated factor VII use may be reasonable but is not evidence based. Reserve fresh frozen plasma for patients with dilutional coagulopathy. If readily available, hemodialysis should be considered, particularly in patients with advanced kidney injury or excessive risk of thromboembolic events. More clinical studies are needed to determine a standardized approach to treating dabigatran-associated intracranial hemorrhage. Institutional protocol development will facilitate safe, efficacious, and timely use of the limited management options.

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“…As these patients are at risk of bleeding, especially from the gastrointestinal tract (eg with dabigatran), patients who are bleeding while receiving these agents should be discussed with coagulation specialists. 19,20 Table 2 summarises the effects that the new oral anticoagulant agents have on the PT and APTT and another clotting test, thrombin time.…”

Section: Prolonged Apttmentioning

confidence: 99%

“…20 The other contributors to liver disease=related bleeding include associated renal impairment, sepsis and anaemia from bleeding itself. 23,25,26 This paradigm shift in medical understanding is now well researched and several publications attest to the fact that abnormal PT and APTT in liver disease patients do not correlate with bleeding in any way.…”

Section: Patients With Liver Disease Bleed Due To Abnormal Pt and Apttmentioning

confidence: 99%

Dispelling myths about coagulation abnormalities in internal medicine

Thachil

2014

Clinical Medicine

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The clotting screen is an 'integral' part of the routine blood tests in most medical wards. It is likely that only with the increasing requests for prothrombin time and activated partial thromboplastin time are abnormal results noted. Interpretation of these results requires good understanding of the coagulation system and problems with the laboratory analysis. Due to variable understanding of this complex system, many misconceptions have arisen in relation to the clinical effects expected from abnormal clotting screens. Some of these are discussed with considerations of appropriate management in those situations.

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Dabigatran: A Cause of Hematologic Emergency

Cited by 17 publications

References 22 publications

Direct oral anticoagulants: integration into clinical practice

Direct oral anticoagulants: integration into clinical practice

Dabigatran-Associated Intracranial Hemorrhage

Dispelling myths about coagulation abnormalities in internal medicine

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