![]() Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). This is particularly important when the recommended agent is a new and/or infrequently employed drug. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. Usage and distribution for commercial purposes requires written permission. This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Both cases also demonstrate the role of hypertension in patients taking oral anticoagulation and the development of intracerebral hemorrhage. Further research is required for a specific antidote for factor Xa inhibitors as the clinical development program is still ongoing and approval is pending however, it would also add further safety to patients on factor Xa inhibitors. Our cases demonstrate that the anticoagulant effect of dabigatran can be promptly and effectively counteracted by idarucizumab under “real world conditions”, thus adding a specific safety option for emergency situations for patients on dabigatran. It has been shown to rapidly reverse the anticoagulant effect of dabigatran in healthy volunteers, and also in the “The Reversal Effects of Idarucizumab on Active Dabigatran” (RE-VERSE AD) study, a phase 3, global, prospective cohort study ( NCT02104947) involving patients on dabigatran requiring urgent intervention/surgery or experiencing life-threatening or uncontrolled bleeding. Idarucizumab is a humanized antibody fragment specifically binding to dabigatran. By that time, the aphasia had partially receded, but hemiparesis was still pronounced (NIHSS 9). Sixteen days after admission, she was transferred to a rehabilitation unit. During the clinical workup, no hematoma growth was detected. Further diagnostics did not reveal any cause of hemorrhage other than elevated blood pressure and anticoagulant treatment. ![]() Elevated blood pressure was treated aggressively to a target of below 140 mm Hg systolic BP. The patient was admitted to our stroke unit. Idarucizumab was administered 45 min after arrival in the ER when measured 3 h later, aPTT and TT were in the normal range (23.9 and 20.6 s, respectively). Dabigatran concentration on admission was measured by the Hemoclot ® test and showed a result below the sensitivity range of the test (50 ng/mL). Creatinine was slightly elevated at 103.8 µmol/L (normal range 58.1–95.92 µmol/L), and creatinine clearance estimated according to the formula of Cockcroft and Gault was 66.8 mL/min. Laboratory findings showed very mildly elevated activated partial thromboplastin time (aPTT) of 30.3 s (normal range 15–30 s) and a moderately elevated thrombin time (TT) of 81.6 s (normal range 17–24 s). CT on admission (Fig 1) showed a large (6.2 × 3.9 × 5.8 cm) lobar intracerebral hemorrhage in the left hemisphere. Blood pressure on admission was 180/80 mm Hg but rose subsequently to 230/120 mm Hg. Further concomitant diseases included coronary heart disease and arterial hypertension. ![]() Her medical history included atrial fibrillation, for which she had taken dabigatran 110 mg b.i.d. She was last seen normal about 3 h earlier. A 74-year-old woman was admitted with an acute onset of aphasia and right-sided hemiparesis (NIHSS on admission 18). ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |