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Dabigatran accumulation in acute kidney injury: is more better than less to prevent bleeding? A case report.

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Title: Dabigatran accumulation in acute kidney injury: is more better than less to prevent bleeding? A case report.
Authors: Matbouli, Rafik1 (AUTHOR), Pantet, Olivier2 (AUTHOR), Castioni, Julien3 (AUTHOR), Vakilzadeh, Nima4 (AUTHOR), Alberio, Lorenzo5 (AUTHOR), Hugli, Olivier1 (AUTHOR) olivier.hugli@chuv.ch
Source: International Journal of Emergency Medicine. 7/17/2024, Vol. 17 Issue 1, p1-5. 5p.
Subject Terms: *HEMORRHAGE risk factors, *HEMORRHAGE prevention, *ANTICOAGULANTS, *BACTERIAL meningitis, *ACUTE kidney failure, *HEMODIALYSIS, *BENZIMIDAZOLES, *PYRIDINE, *ATRIAL fibrillation, *DRUG efficacy, *DISEASE complications
Abstract: Dabigatran is an oral anticoagulant that is mainly renally excreted. Despite its efficacy in preventing thromboembolic events, concerns arise regarding bleeding complications in patients with acute kidney injury. Idarucizumab is its specific antidote and reverses quickly and effectively dabigatran anticoagulation effects in situations of severe bleeding or pending surgical procedures, but its benefit beyond these two indications remains uncertain. We present a case of a woman with atrial fibrillation anticoagulated by dabigatran and admitted with Streptococcus agalactiae meningitis, acute kidney injury and dabigatran accumulation. Idarucizumab was not administered initially as she did not meet its current strict indications. However, subsequently, significant bleeding necessitated its use. A rebound increase in dabigatran concentration was associated with an intracranial hemorrhage, but the combination of additional doses of idarucizumab with hemodialysis lowered the dabigatran concentration and prevented significant rebound increases. Further investigation into the optimal management of dabigatran accumulation and acute kidney injury-associated bleeding is needed to enhance patient outcomes and safety. Early initiation of hemodialysis together with idarucizumab administration may be crucial in preventing life-threatening bleeding events in these patients. [ABSTRACT FROM AUTHOR]
Copyright of International Journal of Emergency Medicine is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Dabigatran accumulation in acute kidney injury: is more better than less to prevent bleeding? A case report.
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  Data: Dabigatran is an oral anticoagulant that is mainly renally excreted. Despite its efficacy in preventing thromboembolic events, concerns arise regarding bleeding complications in patients with acute kidney injury. Idarucizumab is its specific antidote and reverses quickly and effectively dabigatran anticoagulation effects in situations of severe bleeding or pending surgical procedures, but its benefit beyond these two indications remains uncertain. We present a case of a woman with atrial fibrillation anticoagulated by dabigatran and admitted with Streptococcus agalactiae meningitis, acute kidney injury and dabigatran accumulation. Idarucizumab was not administered initially as she did not meet its current strict indications. However, subsequently, significant bleeding necessitated its use. A rebound increase in dabigatran concentration was associated with an intracranial hemorrhage, but the combination of additional doses of idarucizumab with hemodialysis lowered the dabigatran concentration and prevented significant rebound increases. Further investigation into the optimal management of dabigatran accumulation and acute kidney injury-associated bleeding is needed to enhance patient outcomes and safety. Early initiation of hemodialysis together with idarucizumab administration may be crucial in preventing life-threatening bleeding events in these patients. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of International Journal of Emergency Medicine is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1186/s12245-024-00677-3
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              Text: 7/17/2024
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