Comparison of intermittent and continuous extracorporeal treatments for the enhanced elimination of dabigatran

Bouchard, Josée; Ghannoum, Marc; Bernier-Jean, Amélie; Williamson, David; Kershaw, Geoffrey; Weatherburn, Claire; Eris, Josette; Tran, Huyen; Patel, Jignesh P.; Roberts, Darren M.

doi:10.3109/15563650.2015.1004580

Cited by 30 publications

(24 citation statements)

References 36 publications

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“…[25] Dabigatran is mainly cleared renally and haemodialysis has been discussed as an option to rapidly elimininate the drug. [26] However, in our study all deaths occurred in patients taking rivaroxaban which is only partially cleared through kidneys. It has been shown previously that impaired renal function leads to reduced rivaroxaban excretion resulting in increased anti-Xa activity.…”

Section: Discussionmentioning

confidence: 95%

Intracranial haemorrhage in patients treated with direct oral anticoagulants

Beynon

Sakowitz

Störzinger

et al. 2015

Thrombosis Research

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Section: Discussionmentioning

confidence: 95%

Intracranial haemorrhage in patients treated with direct oral anticoagulants

Beynon

Sakowitz

Störzinger

et al. 2015

Thrombosis Research

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“…Because DOACs are absorbed rapidly from the gastrointestinal tract, activated charcoal is generally only useful for impeding absorption when administered within 1–2 hours of ingestion. Hemodialysis removes approximately half of circulating dabigatran over 1.5–5 hours 14 but placement of a dialysis catheter may be problematic in an anticoagulated patient and a rebound increase in plasma dabigatran levels may be observed as redistribution from the extravascular space occurs. The factor Xa inhibitors are not efficiently removed by hemodialysis because they are more heavily protein-bound.…”

Section: 0 General Principles Of Reversalmentioning

confidence: 99%

Measurement and reversal of the direct oral anticoagulants

2017

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Direct oral anticoagulants (DOACs) offer non-inferior efficacy and improved safety compared to vitamin K antagonists (VKAs) for prevention and treatment of venous thromboembolism and prevention of stroke and systemic embolism in non-valvular atrial fibrillation. Unlike VKAs, DOACs do not require routine laboratory monitoring of anticoagulant effect and dose adjustment. In certain situations, however, laboratory assessment of anticoagulant effect may be desirable. Here we review the utility of currently available assays for assessment of DOAC effect and recommend an optimal assessment strategy for each drug, including calibrated dilute thrombin time or ecarin-based assays for dabigatran and calibrated anti-Xa activity assays for the factor Xa inhibitors. We also discuss reversal strategies, both specific and non-specific, for each drug, including the preferential use of idarucizumab for reversal of dabigatran and two agents, andexanet and ciraparantag, currently under development for reversal of rivaroxaban, apixaban and edoxaban.

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“…Several case reports highlighted the efficacy of RRT in the management of patients with dabigatran related bleeding [26]. In a small study, intermittent hemodialysis enhanced elimination of dabigatran more efficiently than CRRT, though dabigatran levels may rebound after cessation of hemodialysis via the effect of redistribution [27]. Dabigatran levels should be repeated and repeat hemodialysis should be considered in patients with a rebound increase in dabigatran concentration.…”

Section: Renal Replacement Therapy In the Management Of Specific Pmentioning

confidence: 99%

The Role of Renal Replacement Therapy in the Management of Pharmacologic Poisonings

Mirrakhimov

Barbaryan

Gray

et al. 2016

International Journal of Nephrology

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Pharmacologic toxicities are common and range from mild to life-threatening. The aim of this study is to review and update the data on the role of renal replacement therapy (RRT) in the management of various pharmacologic poisonings. We aim to provide a focused review on the role of RRT in the management of pharmacological toxicities. Relevant publications were searched in MEDLINE with the following search terms alone or in combination: pharmacologic toxicity, hemodialysis, hemofiltration, renal replacement therapy, toxicology, poisonings, critical illness, and intensive care. The studies showed that a pharmacologic substance should meet several prerequisites to be deemed dialyzable. These variables include having a low molecular weight (<500 Da) and low degree of protein binding (<80%), being water-soluble, and having a low volume of distribution (<1 L/kg). RRT should be strongly considered in critically ill patients presenting with toxic alcohol ingestion, salicylate overdose, severe valproic acid toxicity, metformin overdose, and lithium poisoning. The role of RRT in other pharmacologic toxicities is less certain and should be considered on a case-by-case basis.

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Comparison of intermittent and continuous extracorporeal treatments for the enhanced elimination of dabigatran

Abstract: IHD enhanced elimination of dabigatran more efficiently than CRRT, but their net effect remains poorly defined. Dialysis decisions, including modality and duration, must be individualized based on a risk-benefit assessment.

Cited by 30 publications

References 36 publications

Intracranial haemorrhage in patients treated with direct oral anticoagulants

Intracranial haemorrhage in patients treated with direct oral anticoagulants

Measurement and reversal of the direct oral anticoagulants

The Role of Renal Replacement Therapy in the Management of Pharmacologic Poisonings

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