Removal of Dabigatran by Hemodialysis

• Published in: American journal of kidney diseases Vol. 61; no. 3; pp. 487 - 489
• Main Authors: Chang, Don N., MD, Dager, William E., PharmD, BCPS, Chin, Andrew I., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2013; Elsevier
• Subjects: Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antithrombins - adverse effects; Benzimidazoles - adverse effects; beta-Alanine - adverse effects; beta-Alanine - analogs & derivatives; Biological and medical sciences; Dabigatran; Drug Overdose - etiology; Drug Overdose - therapy; Emergency and intensive care: renal failure. Dialysis management; hemodialysis; Humans; Intensive care medicine; Intracranial Hemorrhages - chemically induced; Male; Medical sciences; Nephrology; Nephrology. Urinary tract diseases; Pradaxa; Renal Dialysis; hemodialysis; Pradaxa; Dabigatran; Nephrology; Serine endopeptidases; Enzyme; Hemodialysis; Enzyme inhibitor; Thrombin; Antithrombin; Urology; Extrarenal dialysis; Peptidases; Antithrombotic agent; Hydrolases
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2012.08.047

Dabigatran is a newly available oral direct thrombin inhibitor approved for anticoagulation therapy to prevent strokes in patients with nonvalvular atrial fibrillation. Unlike warfarin, dabigatran's observed therapeutic window and minimal drug-to-drug interaction suggest that invasive laboratory testing and dose adjustment is not necessary. In circumstances of excessive anticoagulation, such as overdoses, decreased kidney function, or instances of significant bleeding, reversing dabigatran's effects may be necessary. Unlike warfarin, no rapid-acting antidote to reverse the effects of dabigatran is known. However, hemodialysis has been suggested as a method of removing dabigatran and thereby reducing its anticoagulant effect. We describe a case in which hemodialysis was used in an attempt to remove dabigatran in a patient with excessive anticoagulation from dabigatran and severe intracranial hemorrhage. Serial dabigatran levels suggested that hemodialysis removed the drug. However, given the large volume of distribution of dabigatran in the terminal phase of elimination, a rebound in drug level was noted. We suggest that a longer duration of therapy or more continuous modality of hemodialysis may be needed in conjunction with the initial hemodialysis treatment of dabigatran coagulopathy.