Practical management of bleeding due to the anticoagulants dabigatran, rivaroxaban, and apixaban

Fawole, Adewale; Daw, Hamed; Crowther, Mark

doi:10.3949/ccjm.80a.13025

Cited by 63 publications

(59 citation statements)

References 48 publications

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“…10 Dabigatran is the only NOAC with a recommendation for removal by means of hemodialysis. Because the plasma protein binding of apixaban is 87%, 11 we considered plasma exchange to be a reasonable method for rapidly eliminating this drug, although no prior published reports supported this notion. Of note, rivaroxaban has 95% plasma protein binding, so it should have a comparable effect in elimination if apixaban can be eliminated in this way.…”

Section: Discussionmentioning

confidence: 99%

Plasma Exchange for Urgent Apixaban Reversal in a Case of Hemorrhagic Tamponade after Pacemaker Implantation

Lam¹,

Reyes²,

Seger³

2015

Texas Heart Institute Journal

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We report the case of an 82-year-old A pixaban is a novel oral anticoagulant (NOAC) that is used to prevent stroke in patients who have nonvalvular atrial fibrillation (AF). This drug has predictable therapeutic levels that do not require laboratory monitoring; however, there is no specific antidote to reverse its toxicity.1,2 We present a case of hemorrhagic pericarditis and cardiac tamponade after pacemaker implantation in a patient who was taking apixaban because of AF. Novel therapy and subsequent treatment are discussed. Case ReportAn 82-year-old man with sick sinus syndrome and paroxysmal AF presented at our catheterization laboratory from the clinic, with near-syncope and bradycardia (CHADS 2 score, 2 of 6). On 24-hour Holter monitoring, the predominant result was sinus rhythm. An echocardiogram revealed a normal left ventricular ejection fraction (>0.60), grade II (pseudonormal) diastolic dysfunction, no significant valvular regurgitation, and normal pulmonary artery pressures. A dual-chamber permanent pacemaker was implanted to treat the patient's brady-tachy syndrome and because ventricular pacing revealed pacemaker syndrome (hypotension that results from ventricular pacing due to the absence of the atrial kick that normally increases stroke volume during atrioventricular synchrony). During the procedure, the atrial lead was repositioned. One day postoperatively, the patient was discharged from the hospital after undergoing chest radiography (with normal findings), device interrogation, and incision evaluation. Because of his stroke risk, he was prescribed apixaban (5 mg twice/d) at discharge. He had normal renal function (Table I) and a body weight of 172 lb.During the week after pacemaker implantation, the patient developed fatigue, a low-grade fever (99.2 °F), nausea, moderate pleuritic chest pain, and a productive cough with clear sputum. He was readmitted to the hospital. His blood pressure had decreased from 130/77 mmHg after pacemaker implantation to 100/68 mmHg upon readmission, when he was taking no antihypertensive medications. Physical examination revealed an irregular, tachycardic rhythm (100-130 beats/min), and distended neck veins; auscultation yielded diminished bibasilar breath sounds but no quiet heart sounds. Laboratory data revealed acute kidney injury (Table I) and a substantially elevated erythrocyte sedimentation rate and fibrinogen level. The patient's platelet count and coagulation times were normal; his hemoglobin level had decreased from 15 g/dL after pacemaker implantation to 12 g/dL on readmission. He was taken to the cardiac intensive care unit, where he remained hemodynamically stable.Computed axial tomograms (CT) of the chest (Fig. 1) were not conclusive for right ventricular free-wall perforation, although a moderate-to-large circumferential pericardial effusion of 1.7 cm was detected; its Hounsfield density suggested the presence of Case Reports

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Section: Discussionmentioning

confidence: 99%

Plasma Exchange for Urgent Apixaban Reversal in a Case of Hemorrhagic Tamponade after Pacemaker Implantation

Lam¹,

Reyes²,

Seger³

2015

Texas Heart Institute Journal

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“…According to SPC the administration of edoxaban and rivaroxaban should be discontinued at least 24 hours prior to the procedure, and treatment should be restarted as soon as the clinical situation allows (8). Discontinuation of edoxaban and rivaroxaban 48 hours prior to the procedure is recommended in case of performing surgery with high risk of bleeding (Table 4) (12,15).…”

Section: Dabigatranmentioning

confidence: 99%

“…When performing a low risk of bleeding procedure, the treatment with apixaban should be discontinued 24 hours prior to the surgery (Table 4) (15). Apixaban therapy should be resumed as soon as the clinical situation permits.…”

Section: Dabigatranmentioning

confidence: 99%

Direct Oral Anticoagulant Drugs in Dental Clinical Practice

Staško

Janickova

Mikušková

et al. 2017

Acta Medica Martiniana

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A b s t r a c tThe direct oral anticoagulant drugs (DOAC) are generally safe and effective in several clinical settings including acute venous thromboembolic disease, prophylaxis in the postoperative setting, prevention of thromboembolism in patients with non-valvular atrial fibrillation, and in the management of acute coronary syndrome. The relatively short half-life, rapid onset of action, and predictable pharmacokinetics should simplify periprocedural use of the DOAC. The aim of this work is to propose and summarize periprocedural management of patients treated with the DOAC in dental practice and to inform about the principal specifications of this treatment.

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“…Тромбин (фактор IIа) играет центральную роль в образова-нии тромба в процессе гемостаза. Он активирует факторы V, VIII, XI, катализирует превращение фибриногена в фиб-рин, стимулирует агрегацию тромбоцитов [27]. В 2009 г. да-бигатрана этексилат был одобрен в Великобритании и Ев-ропе для профилактики венозных тромбоэмболических осложнений (ВТЭО) у взрослых после эндопротезирова-ния коленного или тазобедренного сустава [28].…”

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New Oral Anticoagulants in the Therapy of Antiphospholipid Syndrome

Сатыбалдыева¹,

Решетняк²

2016

rsp

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Новые оральные антикоагулянты в терапии антифосфолипидного синдрома Сатыбалдыева М.А., Решетняк Т.М.Основным препаратом из группы антикоагулянтов, применяемым для лечения антифосфолипидного син-дрома (АФС), является антагонист витамина К варфарин. Однако у него имеется ряд недостатков, в особен-ности для пациентов, которым требуется длительная, а зачастую и пожизненная профилактика тромбозов. В последнее время были синтезированы новые пероральные антикоагулянты, такие как дабигатрана этекси-лат (Pradaxa ® ), ривароксабан (Xarelto ® ), апиксабан (Eliquis) и др. В отличие от варфарина, они применяются в фиксированных дозах, не требуют рутинного мониторинга, соблюдения диеты, взаимодействуют лишь с небольшим количеством препаратов. Новые пероральные антикоагулянты одобрены для применения по нескольким показаниям, но данные проведенных исследований не применимы для пациентов с АФС. Ожи-дается, что применение этих препаратов позволит улучшить качество жизни пациентов с АФС. Ключевые слова: антифосфолипидный синдром; профилактика тромбозов; пероральные антикоагулянты. Для ссылки: Сатыбалдыева МА, Решетняк ТМ. Новые оральные антикоагулянты в терапии антифосфоли-пидного синдрома. Научно-практическая ревматология. 2016;54(2):219-226. NEW ORAL ANTICOAGULANTS IN THE THERAPY OF ANTIPHOSPHOLIPID SYNDROME Satybaldyeva M.A., Reshetnyak T.M.The vitamin K antagonist warfarin is an essential medicine from a group of anticoagulants, which is used to treat antiphospholipid syndrome (APS). However, it has a number of disadvantages especially in patients who need longterm and frequently lifetime prevention of thromboses. New oral anticoagulants, such as dabigatran etexilate (Pradaxa ® ), rivaroxaban (Xarelto ® ), apixaban (Eliquis) and others, have been recently synthesized. Unlike warfarin, they are administered at fixed doses, require neither routine monitoring nor diet, and interact with drugs only in small amounts. The new oral anticoagulants have been approved for certain indications, but the data of performed trials are inapplicable to patients with APS. These medicines are expected to improve quality of life in patients with this condition.

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Practical management of bleeding due to the anticoagulants dabigatran, rivaroxaban, and apixaban

Cited by 63 publications

References 48 publications

Plasma Exchange for Urgent Apixaban Reversal in a Case of Hemorrhagic Tamponade after Pacemaker Implantation

Plasma Exchange for Urgent Apixaban Reversal in a Case of Hemorrhagic Tamponade after Pacemaker Implantation

Direct Oral Anticoagulant Drugs in Dental Clinical Practice

New Oral Anticoagulants in the Therapy of Antiphospholipid Syndrome

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