Positive Outcome After Intentional Overdose of Dabigatran

Woo, Jason; Kapadia, Neel N.; Phanco, Sarah E.; Lynch, Catherine

doi:10.1007/s13181-012-0276-5

Cited by 42 publications

(31 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In another case report, a 57-year-old woman with a medical history of depression and atrial fibrillation had taken 11.25 g of dabigatran in a suicide attempt [4] . Despite an ecchymosis indicative of prior trauma, there was no evidence of acute bleeding.…”

Section: Discussionmentioning

confidence: 99%

A Massive Intake of Dabigatran: Case-Report and Short Review

Moronval¹,

Legeleux²,

Thomann³

et al. 2015

Journal of Cardiology and Therapy

View full text Add to dashboard Cite

Objective: The toxicity profile of new oral anticoagulants is well established and with their increasing use the adverse events are frequently encountered in clinical practice. Here, we describe the haemostatic abnormalities after a massive ingestion of dabigatran. Case summary: A 69-year-old woman was admitted for suicidal attempt after ingestion of 9 grams of dabigatran (60 x 150mg pills), associated with 400 mg of nebivolol, 600 mg of diazepam and 1.5 grams of amitriptyline. The patient did not suffer from any bleeding events. Only few voluntary massive intakes are until now reported. Discussion: There are only few cases reporting such a massive voluntary intake of dabigatran leading to biological disorders contrasting with no clinically significant intake. This surprising absence of bleeding events in our case could be at least partly explained by the poor gastrointestinal intake of the drug, a functional gastroparesis, and a theoretically self-limiting biological effect. Conclusion: As no antidote is currently available in routine use for dabigatran, a systematic collection of cases of dabigatran toxicity provide an insight into the clinical manifestations and potential therapeutic implications.

show abstract

Section: Discussionmentioning

confidence: 99%

A Massive Intake of Dabigatran: Case-Report and Short Review

Moronval¹,

Legeleux²,

Thomann³

et al. 2015

Journal of Cardiology and Therapy

View full text Add to dashboard Cite

show abstract

“…86 Moreover, a recent case report involving an intentional overdose of dabigatran involved gastric lavage as recommended by a national guidance and administration of activated charcoal. 87,88 In this case, no blood products or factor concentrates were administered, and the patient did not undergo hemodialysis. 88 Despite marked prolongations of baseline TT, the patient did not manifest any signs of overt bleeding and survived the overdose.…”

Section: Clinical Trials and Case Reports On Active Drug Removalmentioning

confidence: 99%

“…87,88 In this case, no blood products or factor concentrates were administered, and the patient did not undergo hemodialysis. 88 Despite marked prolongations of baseline TT, the patient did not manifest any signs of overt bleeding and survived the overdose. It is important to note that because of its action in the gut, activated charcoal is likely only to be a useful therapy if used within 1 to 2 hours of a dose (or overdose) of dabigatran.…”

Section: Clinical Trials and Case Reports On Active Drug Removalmentioning

confidence: 99%

Pathology Consultation on Monitoring Direct Thrombin Inhibitors and Overcoming Their Effects in Bleeding Patients

Winkler

Tormey

2013

American Journal of Clinical Pathology

View full text Add to dashboard Cite

Routine coagulation assays (eg, the prothrombin time) show a relatively poor correlation with the degree of anticoagulation and DTI drug concentrations. Newer assays, such as the ecarin clotting time and dilute thrombin time, may be more useful in assessing DTI anticoagulation, but these assays are not yet widely available. Low-grade DTI-associated bleeds are best managed with cessation of the drug and supportive care, while higher-grade and/or life-threatening bleeds may best be reversed by active drug removal (eg, via the administration of activated charcoal or hemodialysis). At present there is little evidence to suggest that transfusion products such as factor concentrates or thawed plasma are of any particular benefit in DTI reversal; however, these products may play a supportive role in the management of bleeding.

show abstract

“…[12][13][14] In cases of overdose in patients who took their last NOAC dose within two hours to four hours prior, oral activated charcoal may attenuate absorption of the drug. [15][16][17][18] Nonspecific hemostatic factors that have been studied as potential NOAC reversal agents include prothrombic complex concentrates (PCCs), activated PCCs, recombinant activated factor VII (rFVIIa), and fresh frozen plasma. PCCs are the preferred nonspecific hemostatic agent for NOAC reversal; they are plasma-derived products that contain three (factors II, IX, and X) or four (factors II, IX, X, and VII) clotting factors, in addition to variable amounts of heparin and the natural coagulation inhibitors protein C and protein S. Animal studies have demonstrated that PPCs have a variable ability to normalize anticoagulation parameters and to prevent or attenuate bleeding seen with NOAC usage.…”

Section: General Supportive Measuresmentioning

confidence: 99%