Articles  |   November 2016
SEE Question
Article Information
Coagulation and Transfusion / Articles
Articles   |   November 2016
SEE Question
ASA Monitor 11 2016, Vol.80, 42-43.
ASA Monitor 11 2016, Vol.80, 42-43.
A patient who was taking dabigatran for stroke prophylaxis due to atrial fibrillation has fallen and presents to your O.R. for drainage of an epidural hematoma. According to a recent trial of idarucizumab as a reversal agent for dabigatran-induced anticoagulation in acutely bleeding patients, which of the following is most likely true?
Dabigatran, marketed as Pradaxa®, has been available in the United States since 2010, with indications including atrial fibrillation stroke prophylaxis as well as treatment and ongoing prophylaxis of deep vein thrombosis and pulmonary embolus. Dabigatran is a direct thrombin inhibitor. Its benefits include an anticoagulant efficacy similar to warfarin without the need for complex dosing or frequent laboratory checks, as well as a wider therapeutic window, a more rapid onset, and a shorter half-life. It is a prodrug that is metabolized to its active form in the liver. Dabigatran has a half-life of 12 to 14 hours. The peak anti-coagulant effect is 2 to 3 hours after ingestion, and it is primarily renally excreted. The effects of dabigatran can be monitored by prolongation of the ecarin clotting time (eCT), dilute thrombin time (TT), activated partial thromboplastin time, and activated clotting time. Prothrombin time is not useful for measuring dabigatran activity.
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