Successful use of laboratory monitoring to facilitate an invasive procedure for a patient treated with dabigatran

Byron, Mackenzie; Zochert, Sara; Hellwig, Thaddaus; Gavozdea-Barna, Marioara; Gulseth, Michael P.

doi:10.2146/ajhp160168

Cited by 5 publications

(3 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Using a very conservative approach and reporting the only specific intervention in the hip fracture population, Byron et al present a case report in which a patient was delayed for 5 days prior to hemiarthroplasty for her hip fracture. 11 This case does illustrate the impact of renal function as is well established. The patient had a creatinine clearance of 33 mL/min.…”

Section: Discussionmentioning

confidence: 72%

Use of Anticoagulants Remains a Significant Threat to Timely Hip Fracture Surgery

Taranu

Redclift

Williams

et al. 2018

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Introduction:Hip fracture remains the biggest single source of morbidity and mortality in the elderly trauma population, and any intervention focused on quality improvement and system efficiency is beneficial for both patients and clinicians. Two of the variables contributory to improving care and efficiency are time to theater and length of stay, with the overall goal being to improve care as reflected within the achievement of best practice tariff. One of the biggest barriers to optimizing these variables is preinjury anticoagulation.Method:Building on our previous work with warfarin in this population, we utilized a regional hip fracture collaborative network collecting prospective data through the National Hip Fracture Database with custom fields pertaining to all agents, including novel oral anticoagulants.Results:In all, 1965 hip fracture patients median age 83 years (1639 not anticoagulated) were admitted to the 5 centers over 12 months. Median length of stay was 20.71 days; time to theater 23.09 hours, and the populations (anticoagulated vs control) were evenly matched for injury. Anticoagulated patients were delayed to theater (P ≤ .001), were inpatients for longer (P ≤ .001) and gained less best practice tariff (P ≤ .05). All variables per agent were noted and the impact of each assessed.Conclusions:Despite the widespread use of newer anticoagulants, popular due to unmonitored reversal and administration, patients stay longer in hospital and wait longer for surgery than nonanticoagulated patients of the same age and injury. Contemporary perioperative practices impact negatively on the ability to perform timely surgery on hip fracture patients. We propose a guideline specific to the management of anticoagulation in the hip fracture population to aid the optimum preparation of patients for theater, achievement of timely surgery, and potentially reduce length of stay.

show abstract

Section: Discussionmentioning

confidence: 72%

Use of Anticoagulants Remains a Significant Threat to Timely Hip Fracture Surgery

Taranu

Redclift

Williams

et al. 2018

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

show abstract

“…neuraxial procedure) that require minimal to no anticoagulant effect at the time of the procedure. Indeed, the empirical treatment cessation of 1–3 days before the intervention, as suggested in the EU‐SmPC and in the Food and Drug Administration (FDA) Label Information, revealed plasma concentrations of > 30 ng mL −1 at least for dabigatran etexilate and rivaroxaban . However, a recent prospective multicenter study confirmed that a last DOAC intake 3 days before a procedure resulted in minimal (< 30 ng mL −1 ) pre‐procedural anticoagulant effect for almost all patients.…”

Section: When To Measure Direct Oral Anticoagulants and How To Interpmentioning

confidence: 99%

Laboratory testing in patients treated with direct oral anticoagulants: a practical guide for clinicians

Douxfils

Ageno

Samama

et al. 2018

Journal of Thrombosis and Haemostasis

288

366

View full text Add to dashboard Cite

To cite this article: Douxfils J, Ageno W, Samama C-M, Lessire S, ten Cate H, Verhamme P, Dogn e J-M, Mullier F. Laboratory testing in patients treated with direct oral anticoagulants: a practical guide for clinicians. J Thromb Haemost 2018; 16: 209-19. Click to hear Dr Baglin's perspective on the role of the laboratory in treatment with new oral anticoagulants Summary. One of the key benefits of the direct oral anticoagulants (DOACs) is that they do not require routine laboratory monitoring. Nevertheless, assessment of DOAC exposure and anticoagulant effects may become useful in various clinical scenarios. The five approved DOACs (apixaban, betrixaban, dabigatran etexilate, edoxaban and rivaroxaban) have different characteristics impacting assay selection and the interpretation of results. This article provides an updated overview on (i) which test to use (and their advantages and limitations), (ii) when to assay DOAC levels, (iii) how to interpret the results relating to bleeding risk, emergency situations and perioperative management, and (iv) what is the impact of DOACs on routine and specialized coagulation assays. Assays for anti-Xa or anti-IIa activity are the preferred methods when quantitative information is useful, although the situations in which to test for DOAC levels are still debated. Different reagent sensitivities and variabilities in laboratory calibrations impact assay results. International calibration standards for all specific tests for each DOAC are needed to reduce the inter-laboratory variability and allow inter-study comparisons. The impact of the DOACs on hemostasis testing may cause falsepositive or false-negative results; however, these can be minimized by using specific assays and collecting blood samples at trough concentrations. Finally, prospective clinical trials are needed to validate the safety and efficacy of proposed laboratory thresholds in relation to clinical decisions. We offer recommendations on the tests to use for measuring DOACs and practical guidance on laboratory testing to help patient management and avoid diagnostic errors.

show abstract

“…In particular, works on serpent venom are, unarguably, success stories. Some examples are: Batroxobin, a widely used thrombin-like enzyme and commonly extracted from the venom of Bothrops atrox and Bothrops moojeni , has been used as a replacement for thrombin in bleeding injuries 3 ; Ecarin, from Echis carinatus , as the primary reagent for laboratorial tests that monitor anticoagulation 4 ; and Captopril, developed from peptides of the Bothrops jararaca venom, as a widely adopted inhibitor of the angiotensin converting enzyme (ACE). Other examples of venom-derived drugs include: Aggrastat, for myocardial infarct and ischemia; Ancrod, for stroke; Defibrase, for acute cerebral infarction and angina pectoris; Exanta, used as an anti-coagulant; Hemocoagulase, for hemorrhage; and Integrilin, for acute coronary syndrome 5 .…”

Section: Background and Summarymentioning

confidence: 99%

A multi-protease, multi-dissociation, bottom-up-to-top-down proteomic view of the Loxosceles intermedia venom

et al. 2017

View full text Add to dashboard Cite

Venoms are a rich source for the discovery of molecules with biotechnological applications, but their analysis is challenging even for state-of-the-art proteomics. Here we report on a large-scale proteomic assessment of the venom of Loxosceles intermedia, the so-called brown spider. Venom was extracted from 200 spiders and fractioned into two aliquots relative to a 10 kDa cutoff mass. Each of these was further fractioned and digested with trypsin (4 h), trypsin (18 h), pepsin (18 h), and chymotrypsin (18 h), then analyzed by MudPIT on an LTQ-Orbitrap XL ETD mass spectrometer fragmenting precursors by CID, HCD, and ETD. Aliquots of undigested samples were also analyzed. Our experimental design allowed us to apply spectral networks, thus enabling us to obtain meta-contig assemblies, and consequently de novo sequencing of practically complete proteins, culminating in a deep proteome assessment of the venom. Data are available via ProteomeXchange, with identifier PXD005523.

show abstract

Successful use of laboratory monitoring to facilitate an invasive procedure for a patient treated with dabigatran

Abstract: Coagulation assay monitoring for dabigatran, with emphasis on an ECA dabigatran concentration of <50 ng/mL, was used to assess safety regarding bleeding risk before a nonemergent surgical procedure in an 86-year-old woman with a right femoral neck fracture.

Cited by 5 publications

References 11 publications

Use of Anticoagulants Remains a Significant Threat to Timely Hip Fracture Surgery

Use of Anticoagulants Remains a Significant Threat to Timely Hip Fracture Surgery

Laboratory testing in patients treated with direct oral anticoagulants: a practical guide for clinicians

A multi-protease, multi-dissociation, bottom-up-to-top-down proteomic view of the Loxosceles intermedia venom

Contact Info

Product

Resources

About