Dabigatran: Review of Pharmacology and Management of Bleeding Complications of This Novel Oral Anticoagulant

被引：100
作者：
Ganetsky M. [1 ]
Babu K.M. [2 ]
Salhanick S.D. [1 ]
Brown R.S. [3 ]
Boyer E.W. [4 ]
机构：
[1] Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, One Deaconess Rd
[2] Division of Medical Toxicology, Department of Emergency Medicine, The Alpert Medical School/Brown University, Providence, RI
[3] Department of Internal Medicine, Renal Division, Beth Israel Deaconess Medical Center, Boston, MA
[4] Department of Emergency Medicine, UMass Memorial Medical Center, Worcester, MA
来源：
Journal of Medical Toxicology | 2011年 / 7卷 / 4期
关键词：
Dabigatran; Direct thrombin inhibitors; Hemodialysis; Pradaxa;
D O I：
10.1007/s13181-011-0178-y
中图分类号：
学科分类号：
摘要：
Dabigatran (Pradaxa) is a competitive direct thrombin inhibitor approved by the US FDA for prevention of embolic stroke in patients with nonvalvular atrial fibrillation. Dabigatran has a pharmacokinetic profile that produces predictable anticoagulation responses, does not undergo CYP 450 metabolism, has few drug-drug and drug-food interactions, and does not require frequent laboratory monitoring of clotting parameters. Clinicians are rapidly prescribing this agent as a replacement for warfarin therapy. However, no therapeutic agent has been accepted to reliably reverse the hemorrhagic complications of dabigatran. As of yet, there is no solid evidence to guide management of bleeding complications; management should start with local control of bleeding when possible and transfusion of pRBCs if needed. Transfusion of FFP would not be expected to help control bleeding. Limited and mixed data exist for transfusion of factor VIIa and prothrombin complex concentrates; these therapies should be considered as well as dialysis, which will increase elimination in patients with life-threatening or closed-space bleeding due to dabigatran. We present an article that reviews the pharmacokinetics, clinical trial literature, and consensus guidelines regarding this novel oral anticoagulant. © 2011 American College of Medical Toxicology.
引用
收藏
页码：281 / 287
页数：6
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