Maw Thin Thin, Henry Brian L, Singh Tripti
Division of Nephrology.
Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, and.
Clin Nephrol Case Stud. 2014 Aug 20;2:18-22. doi: 10.5414/CNCS108253. eCollection 2014.
Dabigatran is a direct thrombin inhibitor which is approved by the Food and Drug Administration (FDA) for prevention of embolic stroke in patients with atrial fibrillation. Dabigatran has been shown to be non- inferior to warfarin in preventing stroke in patients with atrial fibrillation [1, 6]. The rate of major bleeding in patients taking dabigatran is also similar to that seen in patients on warfarin [1]. Unlike warfarin, there is currently no antidote available for reversal of anticoagulant effects of dabigatran [2, 3]. Dabigatran is excreted renally and accumulates in patients with acute kidney injury (AKI). Hemodialysis has been reported to increase clearance of dabigatran in patients with acute kidney injury and life-threatening bleeding [4, 5]. We present two cases of dabigatran-associated intracranial hemorrhage where hemodialysis was used to accelerate clearance of dabigatran from the blood in patients with normal renal function.
达比加群是一种直接凝血酶抑制剂，已获美国食品药品监督管理局（FDA）批准，用于预防心房颤动患者的栓塞性中风。在预防心房颤动患者中风方面，达比加群已被证明不劣于华法林[1,6]。服用达比加群的患者大出血发生率也与服用华法林的患者相似[1]。与华法林不同，目前尚无用于逆转达比加群抗凝作用的解毒剂[2,3]。达比加群经肾脏排泄，在急性肾损伤（AKI）患者中会蓄积。据报道，血液透析可增加急性肾损伤且有危及生命出血的患者体内达比加群的清除率[4,5]。我们报告两例达比加群相关的颅内出血病例，其中血液透析用于加速肾功能正常患者血液中达比加群的清除。
