title: The use of dabigatran in elderly patients.
abstract: Recent approval by the US Food and Drug Administration (FDA) of dabigatran etexilate, an oral direct thrombin inhibitor, for the prevention of stroke in patients with atrial fibrillation will likely extend its administration in elderly patients. The risk of major overdosage of dabigatran etexilate in this population is, however, much increased owing to frequent renal function impairment, low body weight, drug interactions that cannot be detected with a routine coagulation test, and no antagonist available. We report herein 2 clinical cases, including 1 fatal case, illustrating our concern regarding the risk of bleeding events in elderly patients.
authors.affiliation: Department of Anesthesiology and Critical Care, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 7 Denis Diderot, 2 rue Ambroise-Paré, 75475 Paris CEDEX 10, France. matthieu.m.legrand@gmail.com
authors.forename: Matthieu
authors.initials: M
authors.lastname: Legrand
authors.forename: Joaquim
authors.initials: J
authors.lastname: Mateo
authors.forename: Alice
authors.initials: A
authors.lastname: Aribaud
authors.forename: Sixtine
authors.initials: S
authors.lastname: Ginisty
authors.forename: Pirayeh
authors.initials: P
authors.lastname: Eftekhari
authors.forename: Patrice Tran Ba
authors.initials: PT
authors.lastname: Huy
authors.forename: Ludovic
authors.initials: L
authors.lastname: Drouet
authors.forename: Didier
authors.initials: D
authors.lastname: Payen
mesh_terms: D000284:Administration, Oral; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000097:blood; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood*; D001281:Atrial Fibrillation / Q000150:complications; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood*; D000069604:Dabigatran; D020878:Device Removal; D017809:Fatal Outcome; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000139:chemically induced* / Q000150:complications; D006801:Humans; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood*; D012771:Shock, Hemorrhagic / Q000097:blood / Q000209:etiology*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D001562:Benzimidazoles; D011725:Pyridines; D000069604:Dabigatran