Peetermans Marijke, Pollack Charles, Reilly Paul, Liesenborghs Laurens, Jacquemin Marc, Levy Jerrold H, Weitz Jeffrey I, Verhamme Peter
a Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium ;
b Department of Emergency Medicine , Thomas Jefferson University , Philadelphia , PA , USA ;
Clin Toxicol (Phila). 2016 Sep;54(8):644-6. doi: 10.1080/15563650.2016.1187737. Epub 2016 May 25.
An overdose of oral anticoagulants represents a challenging scenario for emergency physicians. Dabigatran, an oral direct thrombin inhibitor, is increasingly used in place of warfarin. The lack of an antidote is a concern in patients who overdose on dabigatran, even though the drug can be eliminated with hemodialysis. Idarucizumab is an antibody fragment that binds dabigatran with high affinity. It reverses the anticoagulant effect of dabigatran within minutes and is approved for the reversal of dabigatran during emergency situations.
We describe the use of idarucizumab in the management of a 68-year-old woman who was taking dabigatran 150 mg twice daily and ingested 125 capsules. Despite gastric lavage and administration of activated charcoal within two hours of drug intake, the activated partial thromboplastin time (aPTT) and prothrombin time (PT) remained prolonged. The administration of 5 g of intravenous idarucizumab promptly and completely reversed the anticoagulant activity of dabigatran as assessed by routine and specific coagulation assays (aPTT from to 75 to 26 s, PT from 26 to 11 s and diluted thrombin time from 92 to 27 s). The initially planned emergency hemodialysis was canceled.
This case highlights the potential use of idarucizumab for the management of massive dabigatran overdoses.
口服抗凝剂过量对急诊医生来说是一个具有挑战性的情况。达比加群是一种口服直接凝血酶抑制剂，越来越多地被用于替代华法林。对于服用达比加群过量的患者，缺乏解毒剂是一个令人担忧的问题，尽管这种药物可以通过血液透析清除。依达赛珠单抗是一种抗体片段，能与达比加群高亲和力结合。它能在几分钟内逆转达比加群的抗凝作用，并被批准用于紧急情况下逆转达比加群的作用。
我们描述了依达赛珠单抗在一名68岁女性患者中的应用，该患者每天服用两次150毫克达比加群，并摄入了125粒胶囊。尽管在服药后两小时内进行了洗胃和给予活性炭，但活化部分凝血活酶时间（aPTT）和凝血酶原时间（PT）仍延长。静脉注射5克依达赛珠单抗后，通过常规和特定凝血试验评估（aPTT从75秒降至26秒，PT从26秒降至11秒，稀释凝血酶时间从92秒降至27秒），达比加群的抗凝活性迅速且完全逆转。最初计划的紧急血液透析被取消。
该病例突出了依达赛珠单抗在处理大量达比加群过量情况中的潜在用途。
