TEG-unterstützte Therapie einer Dabigatranüberdosierung bei einem Patienten mit akutem Nierenversagen

Lorenz, K.; Schäfer, René

doi:10.1007/s00101-020-00801-x

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…Single‐dose charcoal was used in six of the 29 published cases [dabigatran ( n = 5) and rivaroxaban ( n = 1)] to reduce DOAC absorption (Table 3). 12–35 Even if given late post‐ingestion as in some of our patients, charcoal has been additionally suggested in healthy volunteers to be effective to enhancing rivaroxaban elimination by limiting enteroenteric recycling 39 …”

Section: Discussionmentioning

confidence: 98%

“…Overdose resulting from DOAC self‐ingestion has been poorly reported, mostly as single cases, limited series and PCC reports, representing ~100 cases, with serum/plasma concentration assessment in <20 cases (Table 3). 12–35 Overall, suicidal ingestion does not seem to result in notable bleeding despite high‐ingested amounts and high peak plasma concentrations in most patients. Of note, peak DOAC concentrations in patients included in clinical trials evaluating DOAC for stroke prevention in atrial fibrillation or venous thromboembolism treatment (ie at regular doses) showed a wide inter‐individual variability 3,36 .…”

Section: Discussionmentioning

confidence: 99%

“…Overall, 29 additional cases mostly involving intentional exposure to dabigatran ( n = 15), rivaroxaban ( n = 8) and apixaban ( n = 6) were published (Table 3). 12–35 Only 10 of these 29 cases presented bleeding. A 53‐year‐old man who co‐ingested 200 mg apixaban presented minor oozing from his femoral venous line insertion site, easily controlled with direct pressure and prothrombin complex concentrate 13 .…”

Section: Discussionmentioning

confidence: 99%

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Case series of massive direct oral anticoagulant ingestion—Treatment and pharmacokinetics data

Delrue

Chevillard

Stépanian

et al. 2022

Eur J Clin Investigation

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Background Direct oral anticoagulants (DOAC) are widely used due to favourable benefit/risk ratio. However, consequences of massive ingestion have been poorly investigated. Objectives We aimed to report outcome and pharmacokinetic parameters in patients who massively ingested DOACs. Methods We conducted a 5‐year cohort study including consecutive massive DOAC ingestion patients admitted to two critical care departments. Patients were managed in accordance with standards of care. We collected the main history, clinical, laboratory, management and outcome data. The time‐course of plasma DOAC concentrations measured using specific assays was modelled. Results Twelve patients (3F/9M; age, 55 years [41–63], median [25th–75th percentiles]) were included. Ingestions involved rivaroxaban (n = 7), apixaban (n = 3) and dabigatran (n = 2), with presumed doses of 9.4‐fold [5.0–22.0] the full daily dose. Six patients received activated charcoal but no antidote nor blood‐derived product. No bleeding was observed. One patient died due to refractory cardiogenic shock related to bisoprolol co‐intoxication. Highest observed peak plasma concentrations were 1720 ng/ml (rivaroxaban), 750 ng/ml (apixaban) and 644 ng/ml (dabigatran). Times to reach DOAC concentration below 50 ng/ml were ~20–45 h (rivaroxaban), ~125 h (apixaban) and ~30–50 h (dabigatran). Elimination half‐lives were 2.5–25.5 h (rivaroxaban), 22.0 and 36.5 h (apixaban), and 5.8 and 15.5 h (dabigatran), with substantial interindividual variability and prolongation in case of cardiovascular failure related to co‐intoxicants. Charcoal administration, even if delayed, may have contributed to limit toxicity, possibly by reducing absorption and/or enteroenteric recycling. Conclusion No bleeding was observed in this series of massive DOAC ingestions despite elevated plasma concentrations. No patient required specific haemostatic agents. Charcoal administration should be considered to limit toxicity.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Case series of massive direct oral anticoagulant ingestion—Treatment and pharmacokinetics data

Delrue

Chevillard

Stépanian

et al. 2022

Eur J Clin Investigation

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Aspirin/dabigatran-etexilate

2020

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A Review of Thromboelastography for Nurses

Vollmer

Leshko

Wilson

et al. 2023

Critical Care Nurse

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Background Thromboelastography is a viscoelastic test with multiple potential advantages over conventional coagulation tests in various disease states. Thromboelastography rapidly provides qualitative and quantitative information related to a patient’s coagulation status. Objective To describe recent studies of the use of thromboelastography in various clinical states and how thromboelastography is used in coagulation management. Methods A literature review using the MEDLINE and PubMed databases was conducted. The updated methodology for integrated reviews by Whittemore and Knafl was followed. Coauthors evaluated separate areas that were independently reviewed by other coauthors to ensure appropriateness for inclusion. Results The use of thromboelastography for various clinical conditions with challenging hemostatic profiles has increased. This integrative review covers the use of thromboelastography in patients with trauma, medication-induced coagulopathy, acute and chronic liver failure, and cardiothoracic surgery. Potential future directions are also discussed. Discussion Thromboelastography has numerous potential benefits over conventional coagulation tests for assessing coagulation status in patients in various clinical states. Nurses can support clinical decisions to use the most appropriate test for their patients. Conclusions Each team member should be involved in assessing the usefulness of thromboelastography. Critical care nurses and the multidisciplinary team must identify patients in whom its use is warranted, interpret the results, and provide appropriate interventions in response to the results and clinical status of the patient.

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TEG-unterstützte Therapie einer Dabigatranüberdosierung bei einem Patienten mit akutem Nierenversagen

Cited by 3 publications

References 7 publications

Case series of massive direct oral anticoagulant ingestion—Treatment and pharmacokinetics data

Case series of massive direct oral anticoagulant ingestion—Treatment and pharmacokinetics data

Aspirin/dabigatran-etexilate

A Review of Thromboelastography for Nurses

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