Key result
A 4-hour session of high-flux hemodialysis successfully reduced dabigatran concentrations to undetectable levels (<40 ng/mL) in two patients with normal renal function and intracranial hemorrhage.
Why the study?
Does hemodialysis accelerate the clearance of dabigatran in patients with normal renal function and intracerebral hemorrhage?
Case Report (n=2)
No
Does hemodialysis accelerate the clearance of dabigatran in patients with normal renal function and intracerebral hemorrhage?
Hemodialysis can effectively accelerate the clearance of dabigatran and reverse its anticoagulant effects even in patients with normal renal function experiencing life-threatening hemorrhage.
Answers are grounded in this paper and cite their sources.
Suggests hemodialysis may aid dabigatran reversal in normal renal function ICH; leaves open confirmation before changing practice.
Dabigatran is a direct thrombin inhibitor which is approved by the Food and Drug Administration (FDA) for prevention of embolic stroke in patients with atrial fibrillation. Dabigatran has been shown to be non- inferior to warfarin in preventing stroke in patients with atrial fibrillation [1, 6]. The rate of major bleeding in patients taking dabigatran is also similar to that seen in patients on warfarin [1]. Unlike warfarin, there is currently no antidote available for reversal of anticoagulant effects of dabigatran [2, 3]. Dabigatran is excreted renally and accumulates in patients with acute kidney injury (AKI). Hemodialysis has been reported to increase clearance of dabigatran in patients with acute kidney injury and life-threatening bleeding [4, 5]. We present two cases of dabigatran-associated intracranial hemorrhage where hemodialysis was used to accelerate clearance of dabigatran from the blood in patients with normal renal function.
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Maw et al. (2014) conducted a case report in Intracerebral hemorrhage on dabigatran with normal renal function (n=2). Hemodialysis was evaluated on Dabigatran concentration. A 4-hour session of high-flux hemodialysis successfully reduced dabigatran concentrations to undetectable levels (<40 ng/mL) in two patients with normal renal function and intracranial hemorrhage.
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