Key result
Continuous venovenous hemofiltration clears dabigatran in a septic patient, normalizing aPTT.
Why the study?
Management of dabigatran anticoagulation in patients with severe sepsis and acute renal failure requiring urgent surgery is challenging due to lack of specific reversal agents.
Does continuous venovenous hemofiltration reduce dabigatran levels and normalize aPTT in a patient with severe sepsis and acute renal failure?
Case Report (n=1)
Does continuous venovenous hemofiltration reduce dabigatran levels and normalize aPTT in a patient with severe sepsis and acute renal failure?
Continuous venovenous hemofiltration can effectively remove dabigatran and normalize aPTT in patients with acute renal failure requiring urgent surgery.
Answers are grounded in this paper and cite their sources.
Case-level data suggest CVVH may aid dabigatran clearance in renal failure; hypothesis-generating and requires prospective validation.
The oral anticoagulant dabigatran etexilate can be a challenge when patients need acute surgery. Sepsis and acute renal failure exacerbate the anticoagulant effect. There is no specific reversal agent for dabigatran etexilate, but it can be removed by hemodialysis. We present a case where a patient treated with dabigatran etexilate was admitted to intensive care unit with severe sepsis and acute renal failure and in need of bilateral lower limp amputation due to ischemia. The patient had severe coagulopathy and was treated with continuous venovenous hemofiltration in attempt to remove dabigatran etexilate before surgery.
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Højland et al. (2015) conducted a case report in Severe sepsis, acute renal failure, and severe coagulopathy (n=1). Continuous venovenous hemofiltration was evaluated on Normalization of activated partial thromboplastin time and dabigatran levels. Continuous venovenous hemofiltration was used to remove dabigatran in a septic patient, where normalization of activated partial thromboplastin time correlated with low dabigatran levels.
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