Dabigatran Poses Challenge in Treating Injured Patients
Due to lack of readily available methods to assess degree of anticoagulation, and reverse effects
WEDNESDAY, Nov. 23 (HealthDay News) -- Dabigatran etexilate, a new oral direct thrombin inhibitor, should be used with caution due to a lack of readily available methods to assess the degree of anticoagulation or reverse its effects, posing a threat of fatal bleeding complications for injured patients, according to a letter published in the Nov. 24 issue of the New England Journal of Medicine.
Bryan A. Cotton, M.D., M.P.H., from the Center for Translational Injury Research in Houston, and colleagues highlighted the concerns associated with the use of dabigatran, with special emphasis on acutely injured patients.
The investigators write of three notable concerns regarding dabigatran use: lack of easily available methods to gauge the degree of anticoagulation, lack of an easily available reversal strategy, and the possibility of life-threatening bleeding complications after an injury. Emergency dialysis is the only option for reversal of the effects of dabigatran, which can be very challenging in unstable patients with bleeding or large intracranial hemorrhages. Recently treated injury patients on dabigatran have had poor outcomes. These patients had normal conventional coagulation studies, but grossly abnormal values on rapid thromboelastography, specifically markedly prolonged activated clotting time values.
"We strongly urge that hemorrhagic complications and death resulting from trauma be included as part of the routine surveillance of all newly approved oral anticoagulants," the authors write.
Several authors disclosed financial relationships with biotechnology companies.