Oral direct thrombin inhibitors have improved treatment of non-valvular atrial fibrillation. Safety concerns have been raised since there is no antidote for treatment of secondary haemorrhages and the absence of widely validated test to monitor drug levels. We present a case of dabigatran overdose in an 82-year-old female who was treated with a seemingly appropriate dose.
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Appropriateness of direct oral anticoagulant dosing in patients with atrial fibrillation at a tertiary care hospital in Thailand.
Explor Res Clin Soc Pharm
December 2024
Department of Pharmacy Practice, College of Pharmacy, Rangsit University, Pathum Thani, Thailand.
Article Synopsis
- A study was conducted in Thailand to evaluate the appropriateness of direct oral anticoagulant (DOAC) dosing in hospitalized patients with atrial fibrillation (AF), revealing that many patients were not dosed according to guidelines.
- The study analyzed 120 patients, finding that the overall prevalence of appropriate DOAC dosing was 63.3%, but about one-third received inappropriate doses, with 20% overdosed and 16.7% underdosed.
- Dabigatran had the highest overdosing rate (90%), while apixaban exhibited the most underdosing (21.9%), emphasizing a significant gap in proper anticoagulant management.
[Overdosing of direct oral anticoagulants].
Med Klin Intensivmed Notfmed
June 2024
Klinik I für Innere Medizin, Centrum für integrierte Onkologie Aachen Bonn Köln Düsseldorf, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
Background: Direct oral anticoagulants (DOAC) are increasingly used for prophylaxis and treatment of thromboembolic events. Incorrectly dosed DOAC treatment is associated with excess mortality.
Purpose: This article aims at raising awareness of DOAC overdosing and its causes as well as presenting a diagnostic and therapeutic work-up.
Activated charcoal helps in the diagnosis of dabigatran overdose: A case study.
Int J Clin Pharmacol Ther
July 2024
The direct-acting oral anticoagulant dabigatran etexilate (DE) targets thrombin and is used widely to prevent thromboembolism. A 79-year-old man was admitted to the Emergency Department due to anuria for 2 days. An urgent laboratory examination revealed a serum creatinine concentration of 888 µmol/L.
View Article and Find Full Text PDFClinical guideline on reversal of direct oral anticoagulants in patients with life threatening bleeding.
Eur J Anaesthesiol
May 2024
From the Department of Anaesthesiology, RWTH Aachen University Hospital, Pauwelsstrasse, Aachen, Germany (OG), Department of Paediatric and Obstetric Anaesthesia, Juliane Marie Centre, Rigshospitalet; & Department of Clinical Medicine, Copenhagen University, Denmark (AA), Department of Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester (AA), Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (AA), Department of Anaesthesiology, Larissa University Hospital, Larissa, Greece (EA), Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse, Basel, Switzerland (DB), Department of Anaesthesiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard, Aarhus, Denmark (CF-E) and Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Landsberger Allee, Berlin, Germany (CvH).
Background: Anticoagulation is essential for the treatment and prevention of thromboembolic events. Current guidelines recommend direct oral anticoagulants (DOACs) over vitamin K antagonists in DOAC-eligible patients. The major complication of anticoagulation is serious or life-threatening haemorrhage, which may necessitate prompt haemostatic intervention.
View Article and Find Full Text PDFDabigatran-related serious medication errors: an analysis using data from VigiBase.
Eur J Clin Pharmacol
April 2024
Uppsala Monitoring Centre, Uppsala, Sweden.
Objective: To analyze the serious medication errors (MEs) on dabigatran, and their related factors, in order to avoid or reduce the occurrence of adverse events.
Methods: Serious MEs related to dabigatran were extracted from the WHO global database of reported potential side effects of medicinal products (VigiBase) by using "Medication errors and other product use errors and issues" High Level Group Term (HLGT) of the international Medical Dictionary for Regulatory Activities (MedDRA). Well-documented reports, vigiGrade completeness score ≥ 0.
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