A Review of and Recommendations for the Management of Patients With Life-Threatening Dabigatran-Associated Hemorrhage: A Single-Center University Hospital Experience.
Identifieur interne : 000660 ( Main/Exploration ); précédent : 000659; suivant : 000661A Review of and Recommendations for the Management of Patients With Life-Threatening Dabigatran-Associated Hemorrhage: A Single-Center University Hospital Experience.
Auteurs : Rohit Kumar [États-Unis] ; Roy E. Smith [États-Unis] ; Brian L. Henry [États-Unis]Source :
- Journal of intensive care medicine [ 1525-1489 ] ; 2015.
Descripteurs français
- KwdFr :
- Accident vasculaire cérébral (), Accident vasculaire cérébral (mortalité), Accident vasculaire cérébral (traitement médicamenteux), Anticoagulants (administration et posologie), Antidotes (usage thérapeutique), Antithrombiniques (administration et posologie), Antithrombiniques (effets indésirables), Charbon de bois (usage thérapeutique), Dabigatran (administration et posologie), Dabigatran (effets indésirables), Dialyse rénale, Défaillance multiviscérale (), Défaillance multiviscérale (mortalité), Femelle, Humains, Hémorragie gastro-intestinale (), Hémorragie gastro-intestinale (mortalité), Hémorragies intracrâniennes (), Hémorragies intracrâniennes (mortalité), Hôpitaux universitaires, Indice de gravité médicale, Mâle, Résultat thérapeutique, Temps partiel de thromboplastine, Études rétrospectives.
- MESH :
- administration et posologie : Anticoagulants, Antithrombiniques, Dabigatran.
- effets indésirables : Antithrombiniques, Dabigatran.
- mortalité : Accident vasculaire cérébral, Défaillance multiviscérale, Hémorragie gastro-intestinale, Hémorragies intracrâniennes.
- traitement médicamenteux : Accident vasculaire cérébral.
- usage thérapeutique : Antidotes, Charbon de bois.
- Accident vasculaire cérébral, Dialyse rénale, Défaillance multiviscérale, Femelle, Humains, Hémorragie gastro-intestinale, Hémorragies intracrâniennes, Hôpitaux universitaires, Indice de gravité médicale, Mâle, Résultat thérapeutique, Temps partiel de thromboplastine, Études rétrospectives.
English descriptors
- KwdEn :
- Anticoagulants (administration & dosage), Antidotes (therapeutic use), Antithrombins (administration & dosage), Antithrombins (adverse effects), Charcoal (therapeutic use), Dabigatran (administration & dosage), Dabigatran (adverse effects), Female, Gastrointestinal Hemorrhage (chemically induced), Gastrointestinal Hemorrhage (mortality), Gastrointestinal Hemorrhage (therapy), Hospitals, University, Humans, Intracranial Hemorrhages (chemically induced), Intracranial Hemorrhages (mortality), Intracranial Hemorrhages (therapy), Male, Multiple Organ Failure (chemically induced), Multiple Organ Failure (mortality), Multiple Organ Failure (prevention & control), Partial Thromboplastin Time, Renal Dialysis, Retrospective Studies, Severity of Illness Index, Stroke (drug therapy), Stroke (mortality), Stroke (prevention & control), Treatment Outcome.
- MESH :
- chemical , administration & dosage : Anticoagulants, Antithrombins, Dabigatran.
- chemical , adverse effects : Antithrombins, Dabigatran.
- chemical , therapeutic use : Antidotes, Charcoal.
- chemically induced : Gastrointestinal Hemorrhage, Intracranial Hemorrhages, Multiple Organ Failure.
- drug therapy : Stroke.
- mortality : Gastrointestinal Hemorrhage, Intracranial Hemorrhages, Multiple Organ Failure, Stroke.
- prevention & control : Multiple Organ Failure, Stroke.
- therapy : Gastrointestinal Hemorrhage, Intracranial Hemorrhages.
- Female, Hospitals, University, Humans, Male, Partial Thromboplastin Time, Renal Dialysis, Retrospective Studies, Severity of Illness Index, Treatment Outcome.
Abstract
Dabigatran is an oral direct thrombin inhibitor that is approved for the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation. Dabigatran has several advantages over warfarin including predictable pharmacokinetics and pharmacodynamics which eliminates the need for routine laboratory monitoring, superiority over warfarin in preventing stroke, or systemic embolism without having an increased risk of bleeding. However, as with any anticoagulant, there remains a real chance of bleeding, including major or life-threatening hemorrhage. Many physicians feel comfortable managing bleeding complications on older anticoagulants like warfarin and heparin, due to extensive experience with the medications along with antidotes to reverse their effects as well as established protocols for treating anticoagulant-associated hemorrhage. However, most physicians have limited clinical experience with dabigatran, there is no specific antidote for dabigatran reversal and there is a paucity of protocols, guidelines, and recommendations for how to manage dabigatran-associated hemorrhage. In this review, we present a case series of patients admitted to our institution for management of bleeding while receiving dabigatran. We retrospectively reviewed these cases to evaluate the efficacy and rationale of the various anticoagulation reversal strategies employed in the context of the existing evidence found in the literature. Specific focus is placed on the therapies utilized and the coagulation studies used to manage these patients.
DOI: 10.1177/0885066614527417
PubMed: 24668159
Affiliations:
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Le document en format XML
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universitaires</term><term>Indice de gravité médicale</term><term>Mâle</term><term>Résultat thérapeutique</term><term>Temps partiel de thromboplastine</term><term>Études rétrospectives</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Anticoagulants</term><term>Antithrombins</term><term>Dabigatran</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Antithrombins</term><term>Dabigatran</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antidotes</term><term>Charcoal</term></keywords><keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Anticoagulants</term><term>Antithrombiniques</term><term>Dabigatran</term></keywords><keywords scheme="MESH" qualifier="chemically induced" xml:lang="en"><term>Gastrointestinal Hemorrhage</term><term>Intracranial Hemorrhages</term><term>Multiple Organ 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rétrospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Dabigatran is an oral direct thrombin inhibitor that is approved for the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation. Dabigatran has several advantages over warfarin including predictable pharmacokinetics and pharmacodynamics which eliminates the need for routine laboratory monitoring, superiority over warfarin in preventing stroke, or systemic embolism without having an increased risk of bleeding. However, as with any anticoagulant, there remains a real chance of bleeding, including major or life-threatening hemorrhage. Many physicians feel comfortable managing bleeding complications on older anticoagulants like warfarin and heparin, due to extensive experience with the medications along with antidotes to reverse their effects as well as established protocols for treating anticoagulant-associated hemorrhage. However, most physicians have limited clinical experience with dabigatran, there is no specific antidote for dabigatran reversal and there is a paucity of protocols, guidelines, and recommendations for how to manage dabigatran-associated hemorrhage. In this review, we present a case series of patients admitted to our institution for management of bleeding while receiving dabigatran. We retrospectively reviewed these cases to evaluate the efficacy and rationale of the various anticoagulation reversal strategies employed in the context of the existing evidence found in the literature. Specific focus is placed on the therapies utilized and the coagulation studies used to manage these patients.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Pennsylvanie</li></region></list><tree><country name="États-Unis"><region name="Pennsylvanie"><name sortKey="Kumar, Rohit" sort="Kumar, Rohit" uniqKey="Kumar R" first="Rohit" last="Kumar">Rohit Kumar</name></region><name sortKey="Henry, Brian L" sort="Henry, Brian L" uniqKey="Henry B" first="Brian L" last="Henry">Brian L. Henry</name><name sortKey="Smith, Roy E" sort="Smith, Roy E" uniqKey="Smith R" first="Roy E" last="Smith">Roy E. 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