Dabigatran anticoagulation and Stanford type A aortic dissection: not always a lethal coincidence?

Abstract

induction. Therefore, we also agree that a different median effective dose of dexmedetomidine for LMA insertion would have been obtained if we waited for 15 min. 2 However, during anaesthesia induction, where loss of consciousness is achieved with a hypnotic drug like propofol in our study, the situation is different than when dexmedetomidine is used alone in patients, and even more so in volunteers. In addition, Uzümcügil and colleagues 3 also reported that when dexmedetomidine 1 μg/kg was given 2 min before propofol induction, LMA insertion conditions were comparable with a situation where a combination of propofol and fentanyl 1 μg/kg was given. The haemodynamic effects may also be different during anaesthesia induction, and we did not observe any clinical change in mean arterial pressure before LMA insertion.Therefore, concerning LMA insertion conditions and haemodynamic effects, it may be appropriate to insert an LMA 2 min after dexmedetomidine, instead of 15 min, in the busy clinical setting during anaesthesia induction.

Delayed surgery in patients with acute type A aortic dissection who are receiving novel oral anticoagulants

“…1 Another 4 reports describe the patient surviving at the price Acquired: Aorta: Case Reports ACQ of significant transfusions, whereas 4 others describe the patient dying from intractable coagulopathy despite receiving massive amounts of blood products, coagulation factors, and, in 1 case, idarucizumab. [2][3][4][5][6][7][8][9] There is no consensus regarding the optimal management of these patients. The persistent risk of rupture must be weighed against the risk of intractable bleeding and multiple transfusions.…”

Answer to: Dabigatran anticoagulation and Stanford Type A aortic dissection: not a lethal coincidence

“…4 Fortunately, idarucizumab 5 has been approved by the FDA 6 and the EMA, 7 and we should have this antidote available early in 2016. However, FEIBA is neither designed nor sufficiently tested in the context of dabigatran-induced coagulopathy, and the coagulation boost can be lethal during extracorporeal circulation, which jeopardizes indication and timing of its application.…”

“…Moreover, in a very similar case FEIBA neither normalized clinical bleeding nor corrected altered coagulation measurements in conjunction with high dabigatran plasma levels. 4 Fortunately, idarucizumab 5 has been approved by the FDA 6 and the EMA, 7 and we should have this antidote available early in 2016.…”