title: Advances in anticoagulation: focus on dabigatran, an oral direct thrombin inhibitor.
abstract: Dabigatran is an oral direct thrombin inhibitor with a rapid onset. Patients on dabigatran do not require coagulation monitoring. Recent prospective randomized trials have shown the efficacy of dabigatran for the prevention of venous thromboembolism after knee or hip arthroplasty and for the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation. Because dabigatran is cleared principally by the kidneys, dosage adjustments are required in the setting of renal dysfunction. There currently is no reversal agent for dabigatran although hemodialysis can facilitate its rapid removal in life-threatening circumstances. The management of severe bleeding associated with dabigatran also may include the administration of a procoagulant, such as recombinant activated factor VII. Based on recent guidelines, regional anesthesia should be used cautiously in patients taking this novel oral thrombin inhibitor.
authors: Cardiovascular and Thoracic Anesthesiology and Critical Care Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. yiandoc@hotmail.com
authors: John G T
authors: JG
authors: Augoustides
mesh_terms: D000765:Anesthesia, Conduction; D000925:Anticoagulants / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002626:Chemistry, Pharmaceutical; D000069604:Dabigatran; D000077425:Fondaparinux; D019918:Heart Valve Prosthesis Implantation; D006470:Hemorrhage / Q000139:chemically induced / Q000628:therapy; D006495:Heparin, Low-Molecular-Weight / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D011134:Polysaccharides / Q000494:pharmacology / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013917:Thrombin / Q000037:antagonists & inhibitors*; D054556:Venous Thromboembolism / Q000517:prevention & control; D014812:Vitamin K / Q000037:antagonists & inhibitors; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D015091:beta-Alanine; D014812:Vitamin K; D013917:Thrombin; D000069604:Dabigatran; D000077425:Fondaparinux