Any issues with pt's taking Pradaxa?

mycrofft

mycrofft

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Sort of scarey, but since most or all lab tests for its efficacy are not reliable, you depend upon s/s of clotting disorder or GI/intracranial/other bleeds to titrate effect (usually, stop it and wait and see).
 
I've only ever seen one patient on it, and they weren't bleeding. The Poison Review has covered a number of articles on it. It appears that there's absolutely nothing we can do about it in any case.

Hopefully, physicians have the sense not to prescribe it for high-risk patients (which means the target market comprises about three 40-year-olds who are in a-fib but otherwise healthy).
 
Not yet, but there will be. Funnily enough for a drug company sponsored trial, the data for its efficacy is pretty dodgy as well.
 
There's another new anticoagulant out there that has the same problems as dabigatran but I'll be damned if I can remember the name. Definetly be worth knowing as early notice to the hospital for a trauma patient taking these would be very helpful.

I think the other one can be reversed or partially reversed with PCC though.
 
Probably Dibigatron

Swap a cholride for a iodide and you get a new patent.
 
triemal04 said:
There's another new anticoagulant out there that has the same problems as dabigatran but I'll be damned if I can remember the name. Definetly be worth knowing as early notice to the hospital for a trauma patient taking these would be very helpful.

I think the other one can be reversed or partially reversed with PCC though.
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Rivaroxaban? (or however it's spelled...) can potentially be reversed by PCC, plus they say pt.'s on it don't need as much routine monitoring (INR, coag) as those on warfarin. (So they say anyway)
 
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fma08 said:
Rivaroxaban? (or however it's spelled...) can potentially be reversed by PCC, plus they say pt.'s on it don't need as much routine monitoring (INR, coag) as those on warfarin. (So they say anyway)
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The bolded is the major advantage of the direct thrombin inhibitors. Its use in this area is increasing. Currently the protocol here for someone with severe bleeding on Pradaxa is dialysis (removes more than half of the drug in a few hours) and FFP/rFVII.
 
Dwindlin said:
The bolded is the major advantage of the direct thrombin inhibitors. Its use in this area is increasing. Currently the protocol here for someone with severe bleeding on Pradaxa is dialysis (removes more than half of the drug in a few hours) and FFP/rFVII.
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Do you have anymore info on that? From what I've read, the problem with dabigatran is that FFP and vit K won't have any effect on it. I thought that dialysis was also ineffective, but that may just have been mentioned in passing as it might not be applicable to someone with more severe injuries.
 
triemal04 said:
Do you have anymore info on that? From what I've read, the problem with dabigatran is that FFP and vit K won't have any effect on it. I thought that dialysis was also ineffective, but that may just have been mentioned in passing as it might not be applicable to someone with more severe injuries.
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You are right that Vit. K will do nothing, but since Pradaxa is a competitive inhibitor it makes physiologic sense that we can overwhelm it with FFP/SCC/rFVII. I don't think there are any good studies showing this yet, but it's the best we have. It is dialyzable, but again how much effect dialyzing has on actual outcomes is yet to be determined.
 
Dwindlin said:
You are right that Vit. K will do nothing, but since Pradaxa is a competitive inhibitor it makes physiologic sense that we can overwhelm it with FFP/SCC/rFVII. I don't think there are any good studies showing this yet, but it's the best we have. It is dialyzable, but again how much effect dialyzing has on actual outcomes is yet to be determined.
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It's actually the FFP I was mostly wondering about. From what I've read and been told, FFP (and PCC) won't have any (or maybe at best minimal) effects on dabigatran. If the hospital(s) you're taking patient's to are using it...has it worked? And, do you know how much they had to use relative to someone taking coumadin?

What we were told awhile back was that FFP, platelets and PRBC's would/might be used, but less as a reversal agent than as a standard replacement for blood loss.
 
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