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Zdeňka Hajšmanová, Pavla Šigutová, Alena Lavičková
Idarucizumab is designed to reverse the anticoagulant effect of dabigatran. This case report describes the administration of three independent doses of idarucizumab to a 76-year-old man suffering from atrial flutter being treated with dabigatran to prevent ischaemic stroke. The last dose of dabigatran was administered in the morning of the same day the patient was transferred to hospital because of the need for urgent pericardium puncture. Baseline dTT (dilute thrombin time) reached 700 ng/mL as glomerular filtration (GF) dropped to 0...
February 2018: Hämostaseologie
Stephan Glund, Guanfa Gan, Viktoria Moschetti, Paul Reilly, Markus Honickel, Oliver Grottke, Joanne Van Ryn
Idarucizumab, a humanized monoclonal antibody fragment (Fab), provides rapid and sustained reversal of dabigatran-mediated anticoagulation. Idarucizumab and dabigatran are mainly eliminated via the kidneys. This analysis aimed to characterize the renal elimination of idarucizumab and investigate the influence of idarucizumab on the pharmacokinetics (PK) of dabigatran and vice versa. Studies were conducted in 5/6 nephrectomized rats, in human volunteers with and without renal impairment, and in a porcine liver trauma model...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
Drayton A Hammond, Laura Baumgartner, Craig Cooper, Elisabeth Donahey, Serena A Harris, Jessica M Mercer, Mandy Morris, Mona K Patel, Angela M Plewa-Rusiecki, Alia A Poore, Ryan Szaniawski, Deanna Horner
PURPOSE: To summarize selected meta-analyses and trials related to critical care pharmacotherapy published in 2017. The Critical Care Pharmacotherapy Literature Update (CCPLU) Group screened 32 journals monthly for impactful articles and reviewed 115 during 2017. Two meta-analyses and eight original research trials were reviewed here from those included in the monthly CCPLU. Meta-analyses on early, goal-directed therapy for septic shock and statin therapy for acute respiratory distress syndrome were summarized...
February 26, 2018: Journal of Critical Care
Nicholas Farina, James T Miller
Direct oral anticoagulants are becoming increasingly popular in outpatient use. These medications have lacked specific reversal agents. However, this is changing. The Federal Food and Drug Administration approved idarucizumab for reversal of dabigatran in 2016, and another agent, andexanet alfa, is currently in clinical trials for reversal of rivaroxaban and apixaban. This article examines the efficacy and safety of these emerging reversal agents, as well as other historical agents for reversal of direct oral anticoagulants...
April 2018: Critical Care Nursing Quarterly
Kevin Fortier, Deepti Shroff, Uday N Reebye
BACKGROUND: Dabigatran, rivaroxaban, apixaban and edoxaban are approved novel oral anticoagulants (NOACs) as alternatives to Vitamin K antagonists (VKA). Physicians are prescribing an ever-increasing amount these drugs to their patients due to various advantages over existing medications. AIMS: The objective of this review is to provide the dental professional with current literature surrounding the emergence of NOACs, as well as various case studies on the subject, in an effort to guide clinical decision making regarding these medications...
February 28, 2018: Gerodontology
Bryan D Hayes, Michael E Winters, Steve B Rosenbaum, Mohannad F Allehyani, Gary M Vilke
BACKGROUND: In 2010, the U.S. Food and Drug Administration (FDA) approved dabigatran as the first non-warfarin oral anticoagulant for use in the United States. At the time of FDA approval, there was no antidote or effective treatment for dabigatran-induced hemorrhage. In 2015, the FDA approved idarucizumab for the treatment of dabigatran-induced hemorrhage. The purpose of this clinical practice statement is to evaluate the role of select reversal agents in the management of patients with dabigatran-associated bleeding...
February 15, 2018: Journal of Emergency Medicine
Quentin Mathais, Pierre Esnault, Maximilien Cruc, Cedric Bernard, Bertrand Prunet, Pierre Emmanuel Gaillard
BACKGROUND: While spontaneous spinal epidural hematomas are rare, one of the identified risk factors is vitamin K antagonist therapy. CASE DESCRIPTION: We present a case of a spontaneous spinal epidural hematoma occurring in a patient under treatment with dabigatran, a non-vitamin K oral anticoagulant. The initial hemiparesis symptom was misleading and was retrospectively identified as Brown Sequard syndrome. Immediate dabigatran antagonism with idarucizumab followed by posterior cervical laminectomy permitted a complete neurological recovery at day 4...
February 6, 2018: World Neurosurgery
W T Lo, K F Ng, S Ch Chan, V Wy Kwok, C S Fong, S T Chan, G Ck Wong, W C Fong
No abstract text is available yet for this article.
February 2018: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
Enrique Rodríguez de Santiago, María Sierra Morales, Javier Martínez González
Idarucizumab is a monoclonal antibody that rapidly reverses the anticoagulant effect of dabigatran. The experience with this drug in the setting of gastrointestinal bleeding is scarce. We present the case of an 84-year-old male with known history of non-valvular atrial fibrillation anticoagulated with dabigatran who presented to the emergency room with melena. During his stay in the emergency department he suddenly worsened with hemodynamic derangement and massive melena so idarucizumab was administered. Gastroscopy and colonoscopy were performed without identifying a bleeding source...
January 25, 2018: Revista Española de Enfermedades Digestivas
Emmanuel Touzé, Yves Gruel, Isabelle Gouin-Thibault, Emmanuel De Maistre, Sophie Susen, Pierre Sie, Laurent Derex
BACKGROUND AND PURPOSE: Whereas intravenous thrombolysis (IVT) is allowed in acute ischaemic stroke (IS) in patients on vitamin K antagonists if INR≤1.7, there is no similar recommendations for patients on direct oral anticoagulants (DOACs), notably due to the lack of coagulation tests to assess the therapeutic effects. Although the literature is scarce, consisting in small case series and retrospective studies, considering the frequency of this situation, the French Vascular Neurology Society and the French study Group on Haemostasis and Thrombosis have worked on a joined position paper to provide a practical position regarding emergency management of IS in patients on DOACs...
January 23, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Gian Galeazzo Riario Sforza, Francesco Gentile, Fabio Stock, Francesco Caggiano, Enrica Chiocca, Cristoforo Incorvaia
The recent introduction of direct oral anticoagulants, including rivaroxaban, dabigatran, apixaban, and edoxaban, for the acute treatment and secondary prevention of venous thromboembolism and in atrial fibrillation has been shown to provide greater clinical benefit than oral vitamin K antagonists. However, direct oral anticoagulants are associated with adverse events, the most common being major bleeding; such events require the reversal of the anticoagulant effects by specific agents. In this case report, we describe an 87-year-old female with atrial fibrillation treated with dabigatran who had massive rectal bleeding...
2018: SAGE Open Medical Case Reports
Jerrold H Levy, James Douketis, Jeffrey I Weitz
The non-vitamin K antagonist oral anticoagulants (NOACs) include dabigatran, which inhibits thrombin, and apixaban, betrixaban, edoxaban, and rivaroxaban, which inhibit coagulation factor Xa. Although clinical studies of NOACs were conducted without antidotes, patient outcomes with major bleeding when receiving NOACs were no worse than those in patients treated with a vitamin K antagonist. Nonetheless, in patients with life-threatening bleeding or requiring urgent surgery, the capacity for rapid NOAC reversal is likely to increase patient safety...
January 18, 2018: Nature Reviews. Cardiology
Jennifer Mourafetis, Norman Doctor, Simon Leung
PURPOSE: A case report describing use of idarucizumab for dabigatran reversal without the use of hemostatic agents in a patient who developed acute upper gastrointestinal (GI) bleeding while receiving triple antithrombotic therapy is presented. SUMMARY: A 77-year-old man with a complex cardiac history presented to the emergency room with chief complaints of black tarry stools and low blood pressures for 4 days. His past medical history included recent percutaneous coronary intervention (PCI) and drug-eluting stent (DES) placement, atrial fibrillation, hypertension, hyperlipidemia, coronary artery disease, coronary artery bypass graft surgery, stage 3 chronic kidney disease, and cholecystectomy...
February 15, 2018: American Journal of Health-system Pharmacy: AJHP
Pierre Fontana, Helia Robert-Ebadi, Françoise Boehlen, Marc Righini
New data support the fact that prophylactic anticoagulation with direct oral anticoagulants is effective and safe for the long-term prevention of venous thromboembolism. This type of treatment is dedicated for a subgroup of patients only, which is described in this article. With regard to major bleedings occurring with these anticoagulants, new data have been added to those already available for idarucizumab, a specific antagonist of dabigatran. Finally, we summarize the data regarding a breakthrough molecule, emicizumab, which could potentially open a new era in the management of people with haemophilia A...
January 10, 2018: Revue Médicale Suisse
Charles V Pollack, Paul A Reilly, Jeffrey I Weitz
No abstract text is available yet for this article.
October 26, 2017: New England Journal of Medicine
Marc Sorigue
No abstract text is available yet for this article.
October 26, 2017: New England Journal of Medicine
Ryan P Radecki, Thomas G DeLoughery
No abstract text is available yet for this article.
October 26, 2017: New England Journal of Medicine
Luke Yip, Jou-Fang Deng
No abstract text is available yet for this article.
October 26, 2017: New England Journal of Medicine
Upinder Kaur, Sankha Shubhra Chakrabarti, Sukdev Manna, Indrajeet Singh Gambhir
Dabigatran is a newer oral direct thrombin inhibitor approved by the United States Food and Drug Administration and the European Medicines Agency (EMA). The proper dosage of the drug, the potential for adverse drug reactions and the nature of bleeds with use of this drug as with other novel oral anticoagulants (NOACs), in the elderly population are still areas of uncertainty. Despite the existence of a specific antibody, idarucizumab which is an antidote to dabigatran toxicity, management of dabigatran-induced bleeds is an undefined area especially in resource constrained settings...
January 2018: Therapeutic Advances in Drug Safety
Taylor Steuber
Appropriate treatment of venous thromboembolism (VTE) is critical to minimizing long-term morbidity and mortality. The emergence of direct oral anticoagulants (DOACs) has provided clinicians with expanded therapeutic options for patients with VTE, and as a result, updated practice guidelines released by the American College of Chest Physicians favor DOACs over traditional anticoagulants, such as warfarin. The newest DOAC, betrixaban, received FDA approval in 2017, with an indication for VTE prophylaxis in hospitalized adults...
December 2017: American Journal of Managed Care
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