title: Impaired renal function and bleeding in elderly treated with dabigatran.
abstract: Advantages of dabigatran, a thrombin inhibitor, for stroke prevention in patients with atrial fibrillation are numerous. Elderly patients with impaired renal function are at high risk of bleeding. Recommendations about the renal monitoring in elderly patients are not precise enough. The hemoclot direct thrombin inhibitor (HTI) assay measures accurately the dabigatran activity. Both could help managing serious bleeding events in selected populations. Four elderly patients recently treated with appropriate doses of dabigatran were hospitalized for major bleeding. Three patients were very elderly (> 80 years) and three had impaired renal function (clearance < 50 ml/min) before treatment initiation. Serious bleeding events occurred shortly after dabigatran initiation (< 2 months). In all cases, there was a documented dabigatran plasma overdose associated with a renal function impairment concomitant with the bleeding. Why should physicians be aware of this finding?: A close follow-up of the renal function in clinically fragile elderly patient, before and during the weeks following dabigatran initiation, could help to detect the risk of major bleeding event. The HTI dosage could help managing the treatment in case of severe bleeding event.
authors: aService de cardiologie, AP-HP, Hôpital Bicêtre bService d'hémostase, Hopital Bicêtre, APHP, Le Kremlin-Bicêtre cService de Pharmacologie Clinique, Hopital Bicêtre, APHP, Le Kremlin-Bicêtre dService d'hémostase, Hopital Bicêtre, APHP, Le Kremlin-Bicêtre eService de Cardiologie, AP-HP, Hopital Bicêtre, Univ Paris-Sud, France.
authors: Emmanuelle
authors: E
authors: Berthelot
authors: Cecile
authors: C
authors: Lavenu-Bombled
authors: Lupe
authors: L
authors: Orostegui-Giron
authors: Céline
authors: C
authors: Desconclois
authors: Patrick
authors: P
authors: Assayag
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000517:prevention & control; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects*; D000069604:Dabigatran; D054796:Drug Dosage Calculations; D005260:Female; D006470:Hemorrhage / Q000097:blood* / Q000139:chemically induced; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D007677:Kidney Function Tests; D008297:Male; D051437:Renal Insufficiency / Q000097:blood* / Q000473:pathology; D020521:Stroke / Q000517:prevention & control; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000991:Antithrombins; D001562:Benzimidazoles; D015091:beta-Alanine; D000069604:Dabigatran