title: Dagibatran Etexilate: Is There Any Need for Coagulation Monitoring After Initiation?
abstract: BACKGROUND
  Activated prothrombin time (aPTT) and thrombin time (TT) can serve as indicators for anticoagulation effect of dabigatran etexilate (Pradaxa), the new oral reversible, competitive inhibitor of thrombin. Further, a significant elevation of these coagulation parameters might demonstrate an increased risk of bleeding probably due to an accumulation of dabigatran.
  
  
  METHODS
  We present 2 cases of patients with atrial fibrillation as well as mild and moderate renal impairment, which were treated with dabigatran. The patient with the mild renal impairment [creatinine clearance in 24-hour urine collection (CrCl) 50.2 mL/min] had a comorbid slightly disturbed liver synthesis and prolongation of aPTT. Increased risk of bleeding could be identified by significant elevated coagulation parameters (TT and aPTT) during dabigatran treatment. Further speculative in this case increased risk of bleeding might be due to an accumulation of dabigatran possibly caused by comorbid kidney and liver impairment and an effective gain of dabigatran caused by reduced hepatic synthesis of coagulation factors.
  
  
  CONCLUSIONS
  Especially in multimorbid elderly patients with comorbid liver and kidney dysfunction, a measurement of coagulation parameters not only before but also soon after initiation of treatment might provide additional information about the risk of bleeding.
authors.affiliation: Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Hoepner
authors.forename: Volker
authors.initials: V
authors.lastname: Behrendt
authors.forename: Saskia
authors.initials: S
authors.lastname: Meves
authors.forename: Ralf
authors.initials: R
authors.lastname: Gold
authors.forename: Christos
authors.initials: C
authors.lastname: Krogias
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy*; D001777:Blood Coagulation / Q000187:drug effects*; D000069604:Dabigatran / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008991:Monitoring, Physiologic
chemical_list: D000991:Antithrombins; D000069604:Dabigatran