Safe Use of Hemodialysis for Dabigatran Removal before Cardiac Surgery

Wanek, Matthew; Horn, Edward; Elapavaluru, Subbarao; Baroody, Samuel C; Sokos, George

doi:10.1345/aph.1r081

Cited by 69 publications

(35 citation statements)

References 9 publications

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“…Therefore, dialysis will remove dabigatran and lower plasma dabigatran levels, but, once dialysis is stopped, redistribution of dabigatran back into the plasma from tissues occurs, and a possible increase in bleeding might be observed. 11,[79][80][81][82] Overall, this suggests that more than two hours of dialysis may be required, with the duration dependent on the level of anticoagulation. The decision to stop hemodialysis may be based on normalization of the thrombin time or the observed dabigatran level.…”

Section: 69mentioning

confidence: 99%

Current knowledge on assessing the effects of and managing bleeding and urgent procedures with direct oral anticoagulants

Dager

Hellwig

2016

American Journal of Health-System Pharmacy

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purpose. Current knowledge on managing major bleeding events with available hemostatic agents, including their combined use with potential reversal agents, in patients taking direct oral anticoagulant (DoaCs) is reviewed.Summary. over the past five years, a new generation of oral agents, the DoaCs, has emerged as commonly used anticoagulants for stroke prevention in non-valvular atrial fibrillation, and treatment or secondary prevention of venous thromboembolism. management of a bleeding event in the setting of DoaC therapy should take into account the relative risks of bleeding and thrombosis, which will determine the degree of anticoagulant reversal required. In the setting of a major (critical) bleeding event associated with notable blood loss, management may include transfusions of blood products to sustain the function of organ systems, and the availability of specific reversal agents will provide additional options for bleeding management. beyond withholding the DoaC and providing supportive management that addresses any factors contributing to the bleeding event, clinicians may desire to expedite the removal of any anticoagulation effects. In general, this is accomplished by either removing or neutralizing the anticoagulant or by independently establishing hemostasis. Conclusion.With or without reversal agents, patients may require supportive management such as mechanical pressure, volume support, transfusions of blood products, and, depending on the situation, surgery to repair the bleeding source. specific reversal agents are currently under development or have recently been approved for the urgent management of bleeding events or the facilitation of invasive procedures in patients receiving DoaCs.Am J Health-Syst Pharm. 2016; 73(suppl 2):s14-26

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Section: 69mentioning

confidence: 99%

Current knowledge on assessing the effects of and managing bleeding and urgent procedures with direct oral anticoagulants

Dager

Hellwig

2016

American Journal of Health-System Pharmacy

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“…An evaluation of dabigatran's pharmacological profile suggests that extracorporeal removal can expedite its clearance from plasma (Table 2) [1,2,[28][29][30][31][32]. Several authors have provided evidence to support extracorporeal removal as a strategy to manage dabigatran-related hemorrhage [32][33][34]. We offer a narrative review of the published literature evaluating extracorporeal removal as a therapeutic modality in the management of dabigatran-related hemorrhage.…”

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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“…70,71 Plasma levels of FXa inhibitors are not significantly reduced by dialysis. The only specific reversal agent currently available is idarucizumab, which should be used in patients who develop life-threatening bleeding while taking dabigatran.…”

Section: Management Of Bleeding Complicationsmentioning

confidence: 99%

Drug therapy in anticoagulation: which drug for which patient?

Millar

Laffan

2017

Clinical Medicine

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Four non-vitamin K oral anticoagulants (NOACs) are now licensed and available in the UK, offering unprecedented choices in anticoagulant therapy for clinicians and patients. NOACs have many clear benefi ts over warfarin, the most striking being the reduction in intracranial haemorrhage. However, a number of uncertainties remain: their effi cacy in certain situations, utility of drug assays, signifi cance of drug interactions and management of bleeding. In the absence of any direct comparative trials, it is not clear that any of the NOACs is signifi cantly better than the others in any of the licensed indications. The differential activities, pharmacokinetics, metabolism, excretion and side effects of the agents should be considered when selecting the most appropriate anticoagulant. In this article, we discuss how, with careful selection for the relevant indication, NOACs can simplify therapy while improving outcomes. We aim to provide clinicians with the information needed to select the most suitable anticoagulant drug for an individual patient in a given situation. KEYWORDS : Anticoagulant therapy , non-vitamin K oral anticoagulants , NOACs IntroductionThe non-vitamin K oral anticoagulants (NOACs) 1 are now established in UK practice and new members continue to arrive. Within their licensed indications they have clear benefits over warfarin, but a number of uncertainties remain: efficacy in some specific situations, the utility of drug assays, significance of drug interactions and the management of bleeding all suffer from a paucity of data.This article provides an update on developments since the 2014 review in this journal.2 Our aim is to provide the information needed to select the most suitable anticoagulant drug for an individual patient in a given situation. ABSTRACTDrug therapy in anticoagulation: which drug for which patient? Properties of NOACsFour NOACs are now licensed and available in the UK: the direct factor Xa (FXa) inhibitors apixaban, edoxaban and rivaroxaban, and the direct thrombin inhibitor dabigatran. The key to best choice of agent lies in their individual pharmacokinetic profiles, metabolism and routes of excretion.

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Safe Use of Hemodialysis for Dabigatran Removal before Cardiac Surgery

Cited by 69 publications

References 9 publications

Current knowledge on assessing the effects of and managing bleeding and urgent procedures with direct oral anticoagulants

Current knowledge on assessing the effects of and managing bleeding and urgent procedures with direct oral anticoagulants

Enhanced Elimination of Dabigatran Through Extracorporeal Methods

Drug therapy in anticoagulation: which drug for which patient?

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