Dabigatran and Bleeding: Still an Emergent Situation?

Heukelom, Joel Van; Lal, Yasir

doi:10.1097/maj.0b013e3182960987

Cited by 1 publication

(1 citation statement)

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“…Since dabigatran's approval for clinical use by the Food and Drug Administration (FDA) and European Medicines Agency (EMEA), numerous reports have appeared of bleeding complications [7][8][9][10][11][12][13][14][15][16][17]. In the Randomized Evaluation of Long-term anticoagulation therapY (RE-LY) study, the rate of overall major bleeding was similar between dabigatran and warfarin.…”

Section: Introductionmentioning

confidence: 99%

Enhanced Elimination of Dabigatran Through Extracorporeal Methods

2014

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Several pharmacokinetic studies have suggested that dabigatran possesses a number of ideal properties for expedited removal via extracorporeal methods. However, this practice has not been prospectively evaluated in patients with life-threatening bleeding or requiring emergency surgery secondary to dabigatran-associated coagulopathy. The purpose of this literature review is to evaluate the published evidence surrounding extracorporeal removal of dabigatran in the setting of emergency surgery or life-threatening bleeding. A query of MEDLINE, Web of Science, International Pharmaceutical Abstracts, and Google Scholar using the terms dabigatran, dabigatran etexilate, hemodialysis, renal replacement therapy, hemorrhage, and atrial fibrillation was used to retrieve relevant literature. Furthermore, a manual search of the references of the identified literature was performed to capture additional data. Current evidence suggests that extracorporeal removal of dabigatran may play a role in the setting of life-threatening bleeding and emergent surgery. Conflicting evidence exists with regard to the potential for redistribution based on serum dabigatran concentrations. In addition, a number of practicalities must be considered before incorporating this technique in the clinical setting. Extracorporeal removal of dabigatran may be a treatment modality in selected patients who require emergency reversal.

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