Department of Internal Medicine, Division of Nephrology, University of California, Davis School of Medicine, Sacramento, CA 95817, USA.
Am J Kidney Dis. 2013 Mar;61(3):487-9. doi: 10.1053/j.ajkd.2012.08.047. Epub 2012 Dec 5.
Dabigatran is a newly available oral direct thrombin inhibitor approved for anticoagulation therapy to prevent strokes in patients with nonvalvular atrial fibrillation. Unlike warfarin, dabigatran's observed therapeutic window and minimal drug-to-drug interaction suggest that invasive laboratory testing and dose adjustment is not necessary. In circumstances of excessive anticoagulation, such as overdoses, decreased kidney function, or instances of significant bleeding, reversing dabigatran's effects may be necessary. Unlike warfarin, no rapid-acting antidote to reverse the effects of dabigatran is known. However, hemodialysis has been suggested as a method of removing dabigatran and thereby reducing its anticoagulant effect. We describe a case in which hemodialysis was used in an attempt to remove dabigatran in a patient with excessive anticoagulation from dabigatran and severe intracranial hemorrhage. Serial dabigatran levels suggested that hemodialysis removed the drug. However, given the large volume of distribution of dabigatran in the terminal phase of elimination, a rebound in drug level was noted. We suggest that a longer duration of therapy or more continuous modality of hemodialysis may be needed in conjunction with the initial hemodialysis treatment of dabigatran coagulopathy.
达比加群酯是一种新型的可口服直接凝血酶抑制剂，被批准用于抗凝治疗，以预防非瓣膜性心房颤动患者的中风。与华法林不同，达比加群酯的观察治疗窗和最小的药物相互作用表明，不需要侵入性实验室检测和剂量调整。在抗凝过度的情况下，如过量、肾功能下降或严重出血的情况下，可能需要逆转达比加群酯的作用。与华法林不同，目前还没有用于逆转达比加群酯作用的快速作用解毒剂。然而，已经有人建议使用血液透析来去除达比加群酯，从而降低其抗凝作用。我们描述了一例因达比加群酯抗凝过度和严重颅内出血而使用血液透析试图去除达比加群酯的病例。连续的达比加群酯水平表明血液透析清除了药物。然而，考虑到达比加群酯在消除终末相的分布容积较大，药物水平出现反弹。我们建议，在初始血液透析治疗达比加群酯凝血功能障碍时，可能需要更长时间的治疗或更连续的血液透析方式。
