Verma Ashish, Chhibber Vishesh, Emhoff Timothy, Klinger Dagmar
Division of Renal Medicine , University of Massachusetts Medical School , Worcester, MA , USA.
Department of Transfusion Medicine , University of Massachusetts Medical School , Worcester, MA , USA.
Clin Kidney J. 2012 Aug;5(4):336-8. doi: 10.1093/ckj/sfs068. Epub 2012 Jul 6.
Dabigatran, marketed as Pradaxa (Boehringer Ingelheim) in the USA, is a direct thrombin inhibitor that holds great promise. It has been shown to reduce the risk of stroke and venous thromboembolism with similar if not greater efficacy than warfarin and with far fewer side effects. However, like other anticoagulants, it can cause severe bleeding complications and lacks a specific antidote with proven efficacy. The patient presented here was on dabigatran and sustained a traumatic intracranial hemorrhage (ICH). The ICH continued to progress despite prompt initiation of 3h of hemodialysis in an effort to remove the offending drug from the circulation. Through this case report, we highlight the challenges of anticoagulation with dabigatran including the lack of routine testing for monitoring its effect and of a specific antidote. We also discuss the potential role of dialysis in treating patients with life-threatening bleeding on dabigatran.
达比加群酯在美国以Pradaxa（勃林格殷格翰公司生产）的商品名销售，是一种前景广阔的直接凝血酶抑制剂。研究表明，与华法林相比，它在降低中风和静脉血栓栓塞风险方面疗效相当甚至更好，且副作用少得多。然而，与其他抗凝剂一样，它可导致严重的出血并发症，并且缺乏已证实有效的特效解毒剂。本文介绍的患者正在服用达比加群酯，发生了外伤性颅内出血（ICH）。尽管立即进行了3小时的血液透析以努力从循环中清除有害药物，但颅内出血仍持续进展。通过本病例报告，我们强调了使用达比加群酯进行抗凝治疗的挑战，包括缺乏监测其效果的常规检测方法以及特效解毒剂。我们还讨论了透析在治疗服用达比加群酯出现危及生命出血的患者中的潜在作用。
