Dabigatran Etexilate: Management In Acute Ischemic Stroke

Javedani, Parisa P.; Horowitz, B. Zane; Clark, Wayne M.; Lutsep, Helmi L.

doi:10.4037/ajcc2013125

Cited by 8 publications

(8 citation statements)

References 26 publications

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“…78–81 A handful of case reports suggest safety of endovascular therapy in patients on dabigatran and rivaroxaban even in the setting of abnormal coagulation studies. 82–87 In the previously described cohort study, none of the 33 patients who underwent endovascular therapy with or without intravenous thrombolysis experienced a symptomatic ICH. Reflecting the paucity of data in this area, the AHA’s guidelines provide no recommendations regarding mechanical thrombectomy in patients whose use of anticoagulant medications excludes them from intravenous thrombolysis.…”

Section: Management Of Patients On Noacs Who Are At Risk For Bleedingmentioning

confidence: 99%

Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

Raval¹,

Cigarroa²,

Chung³

et al. 2017

Circulation

218

147

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Non–vitamin K oral anticoagulants (NOACs) are now widely used as alternatives to warfarin for stroke prevention in atrial fibrillation and management of venous thromboembolism. In clinical practice, there is still widespread uncertainty on how to manage patients on NOACs who bleed or who are at risk for bleeding. Clinical trial data related to NOAC reversal for bleeding and perioperative management are sparse, and recommendations are largely derived from expert opinion. Knowledge of time of last ingestion of the NOAC and renal function is critical to managing these patients given that laboratory measurement is challenging because of the lack of commercially available assays in the United States. Idarucizumab is available as an antidote to rapidly reverse the effects of dabigatran. At present, there is no specific antidote available in the United States for the oral factor Xa inhibitors. Prothrombin concentrate may be considered in life-threatening bleeding. Healthcare institutions should adopt a NOAC reversal and perioperative management protocol developed with multidisciplinary input.

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Section: Management Of Patients On Noacs Who Are At Risk For Bleedingmentioning

confidence: 99%

Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

Raval¹,

Cigarroa²,

Chung³

et al. 2017

Circulation

218

147

View full text Add to dashboard Cite

show abstract

“…According to the University of Utah Thrombosis Service's website, a normal aPTT means little anticoagulant activity is present 6. However, a normal aPTT also does not provide clear reassurance to indicate the absence of dabigatran activity 5. Fifteen per cent of patients on D150 had no or minimal aPTT prolongation (<40 s) 11.…”

Section: Discussionmentioning

confidence: 99%

“…Dabigatran etexilate, the parent compound, is an active prodrug that is converted to dabigatran by plasma esterases in the plasma and liver 5. Dabigatran, mostly excreted by the kidneys, has a half-life of 11–14 h in patients with normal renal function.…”

Section: Discussionmentioning

confidence: 99%

“…summarises this test.

Summary of aPTT as a qualitative assessment for dabigatran▸ aPTT is most useful in the initial assessment to determine if dabigatran contributes to a haemorrhagic event9▸ Although normal aPTT suggests little anticoagulant activity,6 this does not indicate absence of drug5▸ Mildly elevated aPTT may also be associated with clinically important levels of dabigatran6▸ The expected median peak aPTT level (for D150) is two-fold that of control while the median trough aPTT is 1.5× control values6 11▸ 15% of patients on D150 had no or minimal aPTT prolongation (<40 s) 11

aPTT, activated partial thromboplastin time.

…”

Section: Discussionmentioning

confidence: 99%

“…▸ Although normal aPTT suggests little anticoagulant activity,6 this does not indicate absence of drug5…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Dabigatran, electrical cardioversion and measuring the aPTT. A safety measure or an unnecessary assessment?

Rahmat

Khan

2013

BMJ Case Reports

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We present two case reports of patients treated with dabigatran for stroke prevention. Both have non-valvular atrial fibrillation and both were scheduled for direct current electrical cardioversion (DCCV). Both had their activated partial thromboplastin time (aPTT) measured prior to their DCCV to assess the anticoagulant activity of dabigatran. The decision to measure the aPTT resulted in differing levels to otherwise straightforward cases.

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Changing Management of Acute Ischaemic Stroke: the New Treatments and Emerging Role of Endovascular Therapy

Asadi

Williams

Thornton

2016

Curr Treat Options Neurol

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Urgent reperfusion of the ischaemic brain is the aim of stroke treatment, and the last two decades have seen a rapid advancement in the medical and endovascular treatment of acute ischaemic stroke. Intravenous tissue plasminogen activator (tPA) was first introduced as a safe and effective thrombolytic agent followed by the introduction of newer thrombolytic agents as well as anticoagulant and antiplatelet agents, proposed as potentially safer drugs with more favourable interaction profiles. In addition to chemo-thrombolysis, other techniques including transcranial sonothrombolysis and microbubble cavitation have been introduced which are showing promising results, but await large-scale clinical trials. These developments in medical therapies which are undoubtedly of great importance due to their potential widespread and immediate availability are paralleled with gradual but steady improvements in endovascular recanalisation techniques which were initiated by the introduction of the MERCI (Mechanical Embolus Removal in Cerebral Ischemia) and Penumbra systems. The introduction of the Solitaire device was a significant achievement in reliable and safe endovascular recanalisation and was followed by further innovative stent retrievers. Initial trials failed to show a solid benefit in endovascular intervention compared with IV-tPA alone. These counterintuitive results did not last long, however, when a series of very well-designed randomised controlled trials, pioneered by MR-CLEAN, EXTEND-IA and ESCAPE, emerged, confirming the well-believed daily anecdotal evidence. There have now been seven positive trials of endovascular treatment for acute ischaemic stroke. Now that level I evidence regarding the superiority of endovascular recanalisation is abundantly available, the clinical challenge is how to select patients suitable for intervention and to familiarise and educate stroke care providers with this recent development in stroke care. It is important for the interventional services to be provided only in comprehensive stroke centres and endovascular interventions attempted by experienced well-trained operators, at this stage as an adjunct to the established medical treatment of IV-tPA, if there are no contraindications.

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Dabigatran Etexilate: Management In Acute Ischemic Stroke

Cited by 8 publications

References 26 publications

Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

Dabigatran, electrical cardioversion and measuring the aPTT. A safety measure or an unnecessary assessment?

Changing Management of Acute Ischaemic Stroke: the New Treatments and Emerging Role of Endovascular Therapy

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