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Efficacy of prothrombin complex concentrates for the emergency reversal of dabigatran-induced anticoagulation

Dabigatran is effective in decreasing the risk of ischaemic stroke in patients with atrial fibrillation. However, like all anticoagulants, it is associated with a risk of bleeding. In cases of trauma or emergency surgery, emergency reversal of dabigatran-induced anticoagulation may be required. A sp...

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Autores principales: Grottke, Oliver, Aisenberg, James, Bernstein, Richard, Goldstein, Patrick, Huisman, Menno V., Jamieson, Dara G., Levy, Jerrold H., Pollack, Charles V., Spyropoulos, Alex C., Steiner, Thorsten, del Zoppo, Gregory J., Eikelboom, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850655/
https://www.ncbi.nlm.nih.gov/pubmed/27125504
http://dx.doi.org/10.1186/s13054-016-1275-8
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author Grottke, Oliver
Aisenberg, James
Bernstein, Richard
Goldstein, Patrick
Huisman, Menno V.
Jamieson, Dara G.
Levy, Jerrold H.
Pollack, Charles V.
Spyropoulos, Alex C.
Steiner, Thorsten
del Zoppo, Gregory J.
Eikelboom, John
author_facet Grottke, Oliver
Aisenberg, James
Bernstein, Richard
Goldstein, Patrick
Huisman, Menno V.
Jamieson, Dara G.
Levy, Jerrold H.
Pollack, Charles V.
Spyropoulos, Alex C.
Steiner, Thorsten
del Zoppo, Gregory J.
Eikelboom, John
author_sort Grottke, Oliver
collection PubMed
description Dabigatran is effective in decreasing the risk of ischaemic stroke in patients with atrial fibrillation. However, like all anticoagulants, it is associated with a risk of bleeding. In cases of trauma or emergency surgery, emergency reversal of dabigatran-induced anticoagulation may be required. A specific reversal agent for dabigatran, idarucizumab, has been approved by the US Food and Drug Administration. Alternative reversal agents are available, such as prothrombin complex concentrates (PCCs) and activated PCCs (aPCCs). In this review we evaluate the role of PCCs and aPCCs in the reversal of dabigatran anticoagulation and consider which tests are appropriate for monitoring coagulation in this setting. Pre-clinical studies, small clinical studies and case reports indicate that PCCs and aPCCs may be able to reverse dabigatran-induced anticoagulation in a dose-dependent manner. However, dosing based on coagulation parameters can be difficult because available assays may not provide adequate sensitivity and specificity for measuring anticoagulation induced by dabigatran or the countering effects of PCCs/aPCCs. In addition, PCCs or aPCCs can potentially provoke thromboembolic complications. Despite these limitations and the fact that PCCs and aPCCs are not yet licensed for dabigatran reversal, their use appears to be warranted in patients with life-threatening haemorrhage if idarucizumab is not available.
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spelling pubmed-48506552016-04-30 Efficacy of prothrombin complex concentrates for the emergency reversal of dabigatran-induced anticoagulation Grottke, Oliver Aisenberg, James Bernstein, Richard Goldstein, Patrick Huisman, Menno V. Jamieson, Dara G. Levy, Jerrold H. Pollack, Charles V. Spyropoulos, Alex C. Steiner, Thorsten del Zoppo, Gregory J. Eikelboom, John Crit Care Review Dabigatran is effective in decreasing the risk of ischaemic stroke in patients with atrial fibrillation. However, like all anticoagulants, it is associated with a risk of bleeding. In cases of trauma or emergency surgery, emergency reversal of dabigatran-induced anticoagulation may be required. A specific reversal agent for dabigatran, idarucizumab, has been approved by the US Food and Drug Administration. Alternative reversal agents are available, such as prothrombin complex concentrates (PCCs) and activated PCCs (aPCCs). In this review we evaluate the role of PCCs and aPCCs in the reversal of dabigatran anticoagulation and consider which tests are appropriate for monitoring coagulation in this setting. Pre-clinical studies, small clinical studies and case reports indicate that PCCs and aPCCs may be able to reverse dabigatran-induced anticoagulation in a dose-dependent manner. However, dosing based on coagulation parameters can be difficult because available assays may not provide adequate sensitivity and specificity for measuring anticoagulation induced by dabigatran or the countering effects of PCCs/aPCCs. In addition, PCCs or aPCCs can potentially provoke thromboembolic complications. Despite these limitations and the fact that PCCs and aPCCs are not yet licensed for dabigatran reversal, their use appears to be warranted in patients with life-threatening haemorrhage if idarucizumab is not available. BioMed Central 2016-04-28 2016 /pmc/articles/PMC4850655/ /pubmed/27125504 http://dx.doi.org/10.1186/s13054-016-1275-8 Text en © Grottke et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Review
Grottke, Oliver
Aisenberg, James
Bernstein, Richard
Goldstein, Patrick
Huisman, Menno V.
Jamieson, Dara G.
Levy, Jerrold H.
Pollack, Charles V.
Spyropoulos, Alex C.
Steiner, Thorsten
del Zoppo, Gregory J.
Eikelboom, John
Efficacy of prothrombin complex concentrates for the emergency reversal of dabigatran-induced anticoagulation
title Efficacy of prothrombin complex concentrates for the emergency reversal of dabigatran-induced anticoagulation
title_full Efficacy of prothrombin complex concentrates for the emergency reversal of dabigatran-induced anticoagulation
title_fullStr Efficacy of prothrombin complex concentrates for the emergency reversal of dabigatran-induced anticoagulation
title_full_unstemmed Efficacy of prothrombin complex concentrates for the emergency reversal of dabigatran-induced anticoagulation
title_short Efficacy of prothrombin complex concentrates for the emergency reversal of dabigatran-induced anticoagulation
title_sort efficacy of prothrombin complex concentrates for the emergency reversal of dabigatran-induced anticoagulation
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850655/
https://www.ncbi.nlm.nih.gov/pubmed/27125504
http://dx.doi.org/10.1186/s13054-016-1275-8
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