ReviewEmergency medicine journal : EMJ2014
The acute management of haemorrhage, surgery and overdose in patients receiving dabigatran.
Review in Emergency medicine journal : EMJ, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 76 citations in OpenAlex.
- Review
- Comparison Effect of Tranexamic Acid (TA) and Tranexamic Acid Combined with Vitamin C (TXC) on Drainage Volume and Atrial Fibrillation Arrhythmia in Patients Undergoing Cardiac Bypass Surgery: Randomized Clinical Trial.Anesthesiology and pain medicine · 2019Article
- Emergency Reversal of Anticoagulation.The western journal of emergency medicine · 2019Review
- The vexed question of whether or not to measure levels of direct oral anticoagulants before surgery or invasive procedures.Internal and emergency medicine · 2018Review
- Severe haematuria of lower urinary tract origin with low dose dabigatran use in three Indian elderly patients: unresolved issues in the safety of novel oral anticoagulants.Therapeutic advances in drug safety · 2018Article
- Italian intersociety consensus on DOAC use in internal medicine.Internal and emergency medicine · 2017Article
- Review
- Nonvitamin K antagonist oral anticoagulant activity: challenges in measurement and reversal.Critical care (London, England) · 2016Review
- Efficacy of prothrombin complex concentrates for the emergency reversal of dabigatran-induced anticoagulation.Critical care (London, England) · 2016Review
- Hemodialysis for removal of dabigatran in a patient with gastric hemorrhage.Acute medicine & surgery · 2016Article
- Direct-Acting Oral Anticoagulants: Practical Considerations for Emergency Medicine Physicians.Emergency medicine international · 2016Review
- Spotlight on idarucizumab and its potential for the reversal of anticoagulant effects of dabigatran.Drug design, development and therapy · 2016Review
- Choosing Non-Vitamin K Antagonist Oral Anticoagulants: Practical Considerations We Need to Know.Ochsner journal · 2016Review
- The Role of Renal Replacement Therapy in the Management of Pharmacologic Poisonings.International journal of nephrology · 2016Review
- Emergency reversal of dabigatran for emergency surgery.BMJ case reports · 2015Article
- Venovenous haemodiafiltration for the management of dabigatran overdose in intensive care unit.Clinical kidney journal · 2015Article
- Differential benefit risk assessment of DOACs in the treatment of venous thromboembolism: focus on dabigatran.Drug design, development and therapy · 2015Review
- Interrupting anticoagulation in patients with nonvalvular atrial fibrillation.P & T : a peer-reviewed journal for formulary management · 2014Article
- Approach to the new oral anticoagulants in family practice: part 2: addressing frequently asked questions.Canadian family physician Medecin de famille canadien · 2014Article
- New oral pharmacotherapeutic agents for venous thromboprophylaxis after total hip arthroplasty.World journal of orthopedics · 2014Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 10 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Dabigatran is an oral direct thrombin inhibitor (DTI) licensed for stroke prevention in atrial fibrillation and likely to be soon approved in Europe for treatment of venous thrombosis. Predictable pharmacokinetics and a reduced risk of intracranial haemorrhage do not negate the potential risk of haemorrhage. Unlike warfarin, there is no reversal agent and measurement of the anticoagulant effect is not 'routine'. The prothrombin time/international normalised ratio response to dabigatran is inconsistent and should not be measured when assessing a patient who is bleeding or needs emergency surgery. The activated partial thromboplastin time (APTT) provides a qualitative measurement of the anticoagulant effect of dabigatran. Knowledge of the time of last dose is important for interpretation of the APTT. Commercially available DTI assays provide a quantitative measurement of active dabigatran concentration in the plasma. If a patient receiving dabigatran presents with bleeding: omit/delay next dose of dabigatran; measure APTT and thrombin time (consider DTI assay if available); administer activated charcoal, with sorbitol, if within 2 h of dabigatran ingestion; give tranexamic acid (1 g intravenously if significant bleeding); maintain renal perfusion and urine output to aid dabigatran excretion. Dabigatran exhibits low protein binding and may be removed by dialysis. Supportive care should form the mainstay of treatment. If bleeding is life/limb threatening, consider an additional haemostatic agent. There is currently no evidence to support the choice of one haemostatic agent (FEIBA, recombinant factor VIIa, prothrombin complex concentrates) over another. Choice will depend on access to and experience with available haemostatic agent(s).
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.