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Safety and timing of resuming dabigatran after major gastrointestinal bleeding reversed by idarucizumab

The recent introduction of direct oral anticoagulants, including rivaroxaban, dabigatran, apixaban, and edoxaban, for the acute treatment and secondary prevention of venous thromboembolism and in atrial fibrillation has been shown to provide greater clinical benefit than oral vitamin K antagonists....

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Autores principales: Riario Sforza, Gian Galeazzo, Gentile, Francesco, Stock, Fabio, Caggiano, Francesco, Chiocca, Enrica, Incorvaia, Cristoforo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768245/
https://www.ncbi.nlm.nih.gov/pubmed/29348918
http://dx.doi.org/10.1177/2050313X17753336
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author Riario Sforza, Gian Galeazzo
Gentile, Francesco
Stock, Fabio
Caggiano, Francesco
Chiocca, Enrica
Incorvaia, Cristoforo
author_facet Riario Sforza, Gian Galeazzo
Gentile, Francesco
Stock, Fabio
Caggiano, Francesco
Chiocca, Enrica
Incorvaia, Cristoforo
author_sort Riario Sforza, Gian Galeazzo
collection PubMed
description The recent introduction of direct oral anticoagulants, including rivaroxaban, dabigatran, apixaban, and edoxaban, for the acute treatment and secondary prevention of venous thromboembolism and in atrial fibrillation has been shown to provide greater clinical benefit than oral vitamin K antagonists. However, direct oral anticoagulants are associated with adverse events, the most common being major bleeding; such events require the reversal of the anticoagulant effects by specific agents. In this case report, we describe an 87-year-old female with atrial fibrillation treated with dabigatran who had massive rectal bleeding. Idarucizumab 5 g (2 × 2.5 g/50 mL) was successfully used to reverse dabigatran effect; subsequent to this, treatment with dabigatran was resumed, and there were no further bleeding events. This suggests that dabigatran can be safely restarted after major bleeding, but this outcome needs to be confirmed in studies involving larger groups of patients.
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spelling pubmed-57682452018-01-18 Safety and timing of resuming dabigatran after major gastrointestinal bleeding reversed by idarucizumab Riario Sforza, Gian Galeazzo Gentile, Francesco Stock, Fabio Caggiano, Francesco Chiocca, Enrica Incorvaia, Cristoforo SAGE Open Med Case Rep Case Report The recent introduction of direct oral anticoagulants, including rivaroxaban, dabigatran, apixaban, and edoxaban, for the acute treatment and secondary prevention of venous thromboembolism and in atrial fibrillation has been shown to provide greater clinical benefit than oral vitamin K antagonists. However, direct oral anticoagulants are associated with adverse events, the most common being major bleeding; such events require the reversal of the anticoagulant effects by specific agents. In this case report, we describe an 87-year-old female with atrial fibrillation treated with dabigatran who had massive rectal bleeding. Idarucizumab 5 g (2 × 2.5 g/50 mL) was successfully used to reverse dabigatran effect; subsequent to this, treatment with dabigatran was resumed, and there were no further bleeding events. This suggests that dabigatran can be safely restarted after major bleeding, but this outcome needs to be confirmed in studies involving larger groups of patients. SAGE Publications 2018-01-09 /pmc/articles/PMC5768245/ /pubmed/29348918 http://dx.doi.org/10.1177/2050313X17753336 Text en © The Author(s) 2018 http://www.creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Case Report
Riario Sforza, Gian Galeazzo
Gentile, Francesco
Stock, Fabio
Caggiano, Francesco
Chiocca, Enrica
Incorvaia, Cristoforo
Safety and timing of resuming dabigatran after major gastrointestinal bleeding reversed by idarucizumab
title Safety and timing of resuming dabigatran after major gastrointestinal bleeding reversed by idarucizumab
title_full Safety and timing of resuming dabigatran after major gastrointestinal bleeding reversed by idarucizumab
title_fullStr Safety and timing of resuming dabigatran after major gastrointestinal bleeding reversed by idarucizumab
title_full_unstemmed Safety and timing of resuming dabigatran after major gastrointestinal bleeding reversed by idarucizumab
title_short Safety and timing of resuming dabigatran after major gastrointestinal bleeding reversed by idarucizumab
title_sort safety and timing of resuming dabigatran after major gastrointestinal bleeding reversed by idarucizumab
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768245/
https://www.ncbi.nlm.nih.gov/pubmed/29348918
http://dx.doi.org/10.1177/2050313X17753336
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