BACKGROUND The drug instructions for dabigatran recommend adjusting the dosage to 110 mg twice daily for patients with bleeding risk,and performing at least one renal function test per year for patients with moderate ...BACKGROUND The drug instructions for dabigatran recommend adjusting the dosage to 110 mg twice daily for patients with bleeding risk,and performing at least one renal function test per year for patients with moderate renal impairment.However,owing to chronic insidiously worsening renal insufficiency,dabigatran can still accumulate abnormally,necessitating therapy with idarucizumab to reverse the anticoagulation due to severe erosive gastritis with widespread stomach mucosal bleeding.CASE SUMMARY A 76-year-old woman with a history of atrial fibrillation who took dabigatran 110 mg twice daily as directed to lessen the chance of stroke,was transported to the hospital with hematemesis and melena.Laboratory findings revealed severe lifethreatening,blood-loss-induced anemia with a hemoglobin(Hb)level of 41.0 g/L and marked coagulation abnormalities with thrombin time(TT)>180 s,most likely caused by dabigatran-induced metabolic disorder.Aggressive acid suppressive,hemostatic,and blood transfusion therapy resulted in the misconception that the bleeding was controlled,with subsequent rebleeding.Idarucizumab was administered in a timely manner to counteract dabigatran’s anticoagulant impact,and 12 h later,TT was determined to be 17.4 s,which was within the normal range.Finally,the patient had no active bleeding signs and laboratory findings showed an Hb level of 104 g/L and TT of 17.7 s.CONCLUSION Renal function,coagulation function,and dabigatran concentration should be regularly monitored in older patients.Proton pump inhibitor and dabigatran coadministration is still controversial in preventing upper gastrointestinal tract bleeding.展开更多
目的:探讨达比加群酯相关肾损伤的临床特点及其防治,为安全用药提供参考。方法:检索PubMed、Ovid、Web of Science、Embase、Springer-link、Wiley Oline Library、CNKI、万方数据库和维普数据库,收集达比加群酯相关肾损伤的文献,检索...目的:探讨达比加群酯相关肾损伤的临床特点及其防治,为安全用药提供参考。方法:检索PubMed、Ovid、Web of Science、Embase、Springer-link、Wiley Oline Library、CNKI、万方数据库和维普数据库,收集达比加群酯相关肾损伤的文献,检索时限均为建库截至2019年1月,提取相关数据进行分析。结果:初筛相关文献156篇,最终纳入符合标准的文献14篇,均来自国外期刊。14篇文献包括达比加群酯相关肾损伤患者14例,其中男9例,女5例;年龄59~89岁,中位年龄为80岁;临床表现主要为出血,其中以血尿为主;在达比加群酯相关肾损伤治疗后,4例肾功能恢复,4例肾功能改善,3例肾功能未恢复,3例肾功能恶化。结论:达比加群酯可能导致肾损伤,在肾损伤相关疾病的基础上也可能导致达比加群酯毒性增加,在出现危及生命的出血的紧急情况下血液透析不一定能达到很好疗效,可使用达比加群酯逆转剂——依达赛珠单抗(idarucizumab)解毒。临床在使用时,应权衡药物使用的利弊,以及时应对不良反应的防治、发生及处理。展开更多
文摘BACKGROUND The drug instructions for dabigatran recommend adjusting the dosage to 110 mg twice daily for patients with bleeding risk,and performing at least one renal function test per year for patients with moderate renal impairment.However,owing to chronic insidiously worsening renal insufficiency,dabigatran can still accumulate abnormally,necessitating therapy with idarucizumab to reverse the anticoagulation due to severe erosive gastritis with widespread stomach mucosal bleeding.CASE SUMMARY A 76-year-old woman with a history of atrial fibrillation who took dabigatran 110 mg twice daily as directed to lessen the chance of stroke,was transported to the hospital with hematemesis and melena.Laboratory findings revealed severe lifethreatening,blood-loss-induced anemia with a hemoglobin(Hb)level of 41.0 g/L and marked coagulation abnormalities with thrombin time(TT)>180 s,most likely caused by dabigatran-induced metabolic disorder.Aggressive acid suppressive,hemostatic,and blood transfusion therapy resulted in the misconception that the bleeding was controlled,with subsequent rebleeding.Idarucizumab was administered in a timely manner to counteract dabigatran’s anticoagulant impact,and 12 h later,TT was determined to be 17.4 s,which was within the normal range.Finally,the patient had no active bleeding signs and laboratory findings showed an Hb level of 104 g/L and TT of 17.7 s.CONCLUSION Renal function,coagulation function,and dabigatran concentration should be regularly monitored in older patients.Proton pump inhibitor and dabigatran coadministration is still controversial in preventing upper gastrointestinal tract bleeding.
文摘目的:探讨达比加群酯相关肾损伤的临床特点及其防治,为安全用药提供参考。方法:检索PubMed、Ovid、Web of Science、Embase、Springer-link、Wiley Oline Library、CNKI、万方数据库和维普数据库,收集达比加群酯相关肾损伤的文献,检索时限均为建库截至2019年1月,提取相关数据进行分析。结果:初筛相关文献156篇,最终纳入符合标准的文献14篇,均来自国外期刊。14篇文献包括达比加群酯相关肾损伤患者14例,其中男9例,女5例;年龄59~89岁,中位年龄为80岁;临床表现主要为出血,其中以血尿为主;在达比加群酯相关肾损伤治疗后,4例肾功能恢复,4例肾功能改善,3例肾功能未恢复,3例肾功能恶化。结论:达比加群酯可能导致肾损伤,在肾损伤相关疾病的基础上也可能导致达比加群酯毒性增加,在出现危及生命的出血的紧急情况下血液透析不一定能达到很好疗效,可使用达比加群酯逆转剂——依达赛珠单抗(idarucizumab)解毒。临床在使用时,应权衡药物使用的利弊,以及时应对不良反应的防治、发生及处理。
