Dabigatran etexilate: appropriate use in patients with chronic kidney disease and in the elderly patients

Molteni, Mauro; Bo, Mario; Minno, Giovanni Di; Pasquale, Giuseppe Di; Genovesi, Simonetta; Toni, Danilo; Verdecchia, Paolo

doi:10.1007/s11739-017-1660-6

Cited by 6 publications

(6 citation statements)

References 80 publications

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“…In fact, although the fixeddose regimen of DOACs offers a clear practical advantage, physicians are likely to question the safety of fixed-dose administration in frail subgroups of patients. In line with these observations, among others, Molteni and co-workers, when reviewing available evidence on the use of dabigatran in patients with CKD and in the elderly, pointed out that that despite in patients with no contraindication to its use, the clinical benefit of dabigatran versus VKAs is independent of renal function, some physicians still perceive mild-tomoderate renal impairment as a relative contraindication to DOAC' use [62].…”

Section: Direct Anticoagulants Agentsmentioning

confidence: 89%

Chronic kidney disease and anticoagulation: from vitamin K antagonists and heparins to direct oral anticoagulant agents

et al. 2017

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Anticoagulation in patients with impaired kidney function can be challenging since drugs' pharmacokinetics and bioavailability are altered in this setting. Patients with chronic kidney disease (CKD) treated with conventional anticoagulant agents [vitamin K antagonist (VKA), low-molecular weight heparin (LMWH) or unfractionated heparin (UFH)] are at high risk of bleeding events (both non-major and major clinically relevant bleeding). While anticoagulation reduces the risk of thromboembolic events, the co-existing bleeding risk and the fact that the most commonly used anticoagulation agents are eliminated via the kidneys pose additional challenges. More recently, two classes of direct oral anticoagulant agents (DOACs) have been investigated for the prevention and management of venous thromboembolic events: the direct factor Xa inhibitors rivaroxaban, apixaban and edoxaban, and the direct thrombin inhibitor dabigatran. In this review, we discuss the complex challenges and the practical considerations associated with the management of anticoagulation treatment in patients with CKD, with a special focus on DOACs.

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Section: Direct Anticoagulants Agentsmentioning

confidence: 89%

Chronic kidney disease and anticoagulation: from vitamin K antagonists and heparins to direct oral anticoagulant agents

et al. 2017

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“…A meta-analysis published by some researchers evaluated the safety and efficacy of dabigatran, apixaban and rivaroxaban in patients with renal insufficiency. DOAC use was compared to warfarin in patients with mild (defined as eGFR 50–79 mL/min) and moderate (defined as eGFR of 30–49 mL/min) renal impairment and found that DOAC use reduced the risk of stroke, systemic embolism and major and non-major bleeding[ 31 ]. Dabigatran 150 mg twice daily was approved by the FDA for atrial fibrillation for patients with eGFR > 30 mL/min and 75 mg twice daily for patients with eGFR 15-29 mL/min[ 6 ].…”

Section: Consideration In Kidney Diseasementioning

confidence: 99%

“…Dabigatran 150 mg twice daily was approved by the FDA for atrial fibrillation for patients with eGFR > 30 mL/min and 75 mg twice daily for patients with eGFR 15-29 mL/min[ 6 ]. Based on real-world data, the use of DOACs is strongly discouraged in patients with end-stage renal disease (ESRD)[ 31 ]. After RE-COVER, RE-COVER II, RE-MEDY, and RE-SONATE trials, the FDA approved dabigatran 150 mg BID (after 5-10 d of parenteral anticoagulation) for the treatment of DVT and PE in patients with eGFR > 30 mL/min and recommends against the use in patients with eGFR < 30 mL/min[ 9 ].…”

Section: Consideration In Kidney Diseasementioning

confidence: 99%

Dabigatran in cardiovascular disease management: A comprehensive review

Javed¹,

Ajmal²,

Wolfson³

2021

WJC

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Dabigatran, a direct thrombin inhibitor, has robust data for the treatment of deep venous thrombosis and pulmonary embolism, stroke prevention in non-valvular atrial fibrillation, and the prophylaxis of venous thromboembolism (VTE) after knee and hip replacement. Recent studies have evaluated dabigatran to determine its safety and efficacy in such conditions as VTE in malignancy, coronary artery disease, mechanical and bioprosthetic valves, and antiphospholipid syndrome. This article provides a comprehensive review on the role of dabigatran in various cardiovascular diseases.

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“…Therefore, a patient’s advanced age or renal insufficiency should not discourage physicians from initiating or maintaining chronic oral anticoagulation with DOACs in patients with AF. 68 …”

Section: Renal Failure and Doac Use In The Covid-19 Pandemicmentioning

confidence: 99%

Dabigatran, the oral anticoagulant of choice at discharge in patients with non-valvular atrial fibrillation and COVID-19 infection: the ANIBAL* protocol

Iturbe-Hernandez¹,

Romualdo²,

Ortega³

et al. 2020

DIC

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Atrial fibrillation is a frequent complication among patients with severe coronavirus disease-2019 (COVID-19) infection. Both direct and indirect mechanisms through COVID-19 have been described to explain this relationship. COVID-19 infection increases the risk of developing both arterial and venous thrombotic complications through systemic coagulation activation, leading to increased mortality. Chronic oral anticoagulation is essential to reduce the thromboembolic risk among AF patients. Switching to low-molecular-weight heparin has been recommended during hospitalization for COVID-19 infection. Of note, at discharge, the prescription of direct oral anticoagulants may offer some advantages over vitamin K antagonists. However, oral anticoagulants should only be prescribed after the consideration of drug–drug interactions with antiviral therapies as well as of the risk of hepatotoxicity, which is common among individuals with severe COVID-19 pneumonia. Not all anticoagulants have the same risk of hepatotoxicity; dabigatran has shown a good efficacy and safety profile and could have a lower risk of hepatotoxicity. Furthermore, its metabolism by cytochrome P450 is absent and it has a specific reversal agent. Therefore, dabigatran may be considered as a first-line choice for oral anticoagulation at discharge after COVID-19 infection. In this review, the available information on the antithrombotic management of AF patients at discharge after COVID-19 infection is updated. In addition, a practical algorithm, considering renal and liver function, which facilitates the anticoagulation choice at discharge is presented.

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Dabigatran etexilate: appropriate use in patients with chronic kidney disease and in the elderly patients

Cited by 6 publications

References 80 publications

Chronic kidney disease and anticoagulation: from vitamin K antagonists and heparins to direct oral anticoagulant agents

Chronic kidney disease and anticoagulation: from vitamin K antagonists and heparins to direct oral anticoagulant agents

Dabigatran in cardiovascular disease management: A comprehensive review

Dabigatran, the oral anticoagulant of choice at discharge in patients with non-valvular atrial fibrillation and COVID-19 infection: the ANIBAL* protocol

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