Rosenberg Lene, Gerstrøm Gustav, Nybo Mads
Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.
Department of Anesthesiology, Lillebaelt Hospital, Vejle, Denmark.
Basic Clin Pharmacol Toxicol. 2017 Apr;120(4):407-410. doi: 10.1111/bcpt.12696. Epub 2016 Dec 16.
Dabigatran, an oral direct thrombin inhibitor, is frequently used in treatment of venous thromboembolism and prevention of stroke in non-valvular atrial fibrillation. Recently, idarucizumab, a monoclonal antibody fragment that reverses the dabigatran effect, was introduced to the market to be used in case of life-threatening bleeding or acute surgery/invasive procedures. Whether usage should be guided by measurement of plasma dabigatran and/or other coagulation parameters is, however, still uncertain. We here describe the use of idarucizumab prior to acute surgery in a patient on dabigatran and acetylsalicylic acid. In this case, the decision to use idarucizumab was based on the clinical manifestations and other routine coagulation parameters, as the plasma dabigatran concentration was not available prior to administration. Due to challenges with the plasma dabigatran analysis and taking the safety of idarucizumab into consideration, it could be questioned whether a dabigatran measurement in general is necessary in this setting. Based on this case, we suggest a scheduled approach when considering requesting a plasma dabigatran measurement prior to administration of idarucizumab.
达比加群是一种口服直接凝血酶抑制剂，常用于治疗静脉血栓栓塞和预防非瓣膜性心房颤动患者的中风。最近，一种可逆转达比加群作用的单克隆抗体片段——艾达赛珠单抗已投放市场，用于治疗危及生命的出血或进行急诊手术/侵入性操作的情况。然而，使用艾达赛珠单抗是否应以血浆达比加群及/或其他凝血参数的测定为指导仍不确定。我们在此描述了在一名服用达比加群和阿司匹林的患者进行急诊手术前使用艾达赛珠单抗的情况。在该病例中，使用艾达赛珠单抗的决定是基于临床表现和其他常规凝血参数做出的，因为给药前无法获得血浆达比加群浓度。鉴于血浆达比加群分析存在困难并考虑到艾达赛珠单抗的安全性，在这种情况下是否一般都需要测定达比加群值得质疑。基于该病例，我们建议在考虑给药前测定血浆达比加群时采用一种有计划的方法。
