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Normalization of Activated Partial Thromboplastin Time Correlates with Low Levels of Dabigatran in a Patient with Severe Sepsis.

Højland RE, Thorup SB, Rasmussen BS - Case Rep Crit Care (2015)

Bottom Line: Sepsis and acute renal failure exacerbate the anticoagulant effect.There is no specific reversal agent for dabigatran etexilate, but it can be removed by hemodialysis.We present a case where a patient treated with dabigatran etexilate was admitted to intensive care unit with severe sepsis and acute renal failure and in need of bilateral lower limp amputation due to ischemia.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia and Intensive Care, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.

ABSTRACT
The oral anticoagulant dabigatran etexilate can be a challenge when patients need acute surgery. Sepsis and acute renal failure exacerbate the anticoagulant effect. There is no specific reversal agent for dabigatran etexilate, but it can be removed by hemodialysis. We present a case where a patient treated with dabigatran etexilate was admitted to intensive care unit with severe sepsis and acute renal failure and in need of bilateral lower limp amputation due to ischemia. The patient had severe coagulopathy and was treated with continuous venovenous hemofiltration in attempt to remove dabigatran etexilate before surgery.

No MeSH data available.


Related in: MedlinePlus

aPTT and dabigatran plasma concentration versus time after CVVH.
© Copyright Policy - open-access
Related In: Results  -  Collection


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fig1: aPTT and dabigatran plasma concentration versus time after CVVH.

Mentions: Ecarin clotting time and thrombin clotting time are the most sensitive tests for evaluating the anticoagulant effects of dabigatran, but these tests are often not available in the daily clinical practice. aPTT is widely available and can be useful in determining excessive anticoagulant activity but cannot be used for precise evaluation of the anticoagulant activity [2]. In our case aPTT was used to evaluate the effect of CVVH on removing dabigatran. To gain knowledge we collected numerous blood samples for measurement of the plasma concentration of dabigatran, which is not available in the acute situation at our hospital. These measurements showed that the curves for plasma dabigatran and aPTT were almost parallel, indicating that aPTT can be used to guide the elimination of dabigatran in ICU (Figure 1).


Normalization of Activated Partial Thromboplastin Time Correlates with Low Levels of Dabigatran in a Patient with Severe Sepsis.

Højland RE, Thorup SB, Rasmussen BS - Case Rep Crit Care (2015)

aPTT and dabigatran plasma concentration versus time after CVVH.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4499610&req=5

fig1: aPTT and dabigatran plasma concentration versus time after CVVH.
Mentions: Ecarin clotting time and thrombin clotting time are the most sensitive tests for evaluating the anticoagulant effects of dabigatran, but these tests are often not available in the daily clinical practice. aPTT is widely available and can be useful in determining excessive anticoagulant activity but cannot be used for precise evaluation of the anticoagulant activity [2]. In our case aPTT was used to evaluate the effect of CVVH on removing dabigatran. To gain knowledge we collected numerous blood samples for measurement of the plasma concentration of dabigatran, which is not available in the acute situation at our hospital. These measurements showed that the curves for plasma dabigatran and aPTT were almost parallel, indicating that aPTT can be used to guide the elimination of dabigatran in ICU (Figure 1).

Bottom Line: Sepsis and acute renal failure exacerbate the anticoagulant effect.There is no specific reversal agent for dabigatran etexilate, but it can be removed by hemodialysis.We present a case where a patient treated with dabigatran etexilate was admitted to intensive care unit with severe sepsis and acute renal failure and in need of bilateral lower limp amputation due to ischemia.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia and Intensive Care, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.

ABSTRACT
The oral anticoagulant dabigatran etexilate can be a challenge when patients need acute surgery. Sepsis and acute renal failure exacerbate the anticoagulant effect. There is no specific reversal agent for dabigatran etexilate, but it can be removed by hemodialysis. We present a case where a patient treated with dabigatran etexilate was admitted to intensive care unit with severe sepsis and acute renal failure and in need of bilateral lower limp amputation due to ischemia. The patient had severe coagulopathy and was treated with continuous venovenous hemofiltration in attempt to remove dabigatran etexilate before surgery.

No MeSH data available.


Related in: MedlinePlus