title: Enhanced elimination of dabigatran through extracorporeal methods.
abstract: Several pharmacokinetic studies have suggested that dabigatran possesses a number of ideal properties for expedited removal via extracorporeal methods. However, this practice has not been prospectively evaluated in patients with life-threatening bleeding or requiring emergency surgery secondary to dabigatran-associated coagulopathy. The purpose of this literature review is to evaluate the published evidence surrounding extracorporeal removal of dabigatran in the setting of emergency surgery or life-threatening bleeding. A query of MEDLINE, Web of Science, International Pharmaceutical Abstracts, and Google Scholar using the terms dabigatran, dabigatran etexilate, hemodialysis, renal replacement therapy, hemorrhage, and atrial fibrillation was used to retrieve relevant literature. Furthermore, a manual search of the references of the identified literature was performed to capture additional data. Current evidence suggests that extracorporeal removal of dabigatran may play a role in the setting of life-threatening bleeding and emergent surgery. Conflicting evidence exists with regard to the potential for redistribution based on serum dabigatran concentrations. In addition, a number of practicalities must be considered before incorporating this technique in the clinical setting. Extracorporeal removal of dabigatran may be a treatment modality in selected patients who require emergency reversal.
authors.affiliation: Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Room 423, Piscataway, NJ, USA, nadia@pharmacy.rutgers.edu.
authors.forename: Nadia I
authors.initials: NI
authors.lastname: Awad
authors.forename: Luigi
authors.initials: L
authors.lastname: Brunetti
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
mesh_terms: D000991:Antithrombins / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning*; D001682:Biological Availability; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D000075202:Contraindications; D000069604:Dabigatran / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning*; D062787:Drug Overdose / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D004632:Emergency Medical Services; D019317:Evidence-Based Medicine; D017583:Hemodiafiltration / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D065667:Renal Elimination; D014018:Tissue Distribution; D015854:Up-Regulation
chemical_list: D000991:Antithrombins; D000069604:Dabigatran