The effect of ultrafiltration with cardiopulmonary bypass on the removal of dabigatran from the circulation of adult pigs
| Autor: | Rupak Mukherjee, Alicia Sievert, John M. Toole, Walter E. Uber, Walter F. DeNino, Christopher B. Carter, Ashley Goss |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Whole Blood Coagulation Time Swine medicine.drug_class medicine.medical_treatment Ultrafiltration 030204 cardiovascular system & hematology Hematocrit Antithrombins law.invention Dabigatran 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine law medicine.artery medicine Cardiopulmonary bypass Animals Radiology Nuclear Medicine and imaging 030212 general & internal medicine Renal artery Advanced and Specialized Nursing Creatinine Cardiopulmonary Bypass medicine.diagnostic_test Heparin business.industry Anticoagulant General Medicine Surgery chemistry Direct thrombin inhibitor Anesthesia Hemodialysis Cardiology and Cardiovascular Medicine business Safety Research medicine.drug |
| Zdroj: | Perfusion. 31:424-430 |
| ISSN: | 1477-111X 0267-6591 |
| DOI: | 10.1177/0267659115614640 |
| Popis: | Objective: Dabigatran etexilate is a direct thrombin inhibitor approved for use in patients with non-valvular atrial fibrillation. There is no currently available pharmacological therapy to reverse this renally cleared anticoagulant. Dabigatran has a low level of plasma protein binding and has been considered dialyzable. We used a pig model with renal artery ligation to exclude intrinsic drug excretion to examine the efficacy of ultrafiltration (UF) during cardiopulmonary bypass (CPB) for dabigatran removal. Method: Dabigatran was intravenously infused (20 mg) in Yorkshire pigs (male, n=7, 70±1 kg) following renal artery ligation. CPB with UF was initiated after heparinization and continued until a total volume of 6 liters of UF effluent was removed. Serial labs, including dabigatran concentration, activated coagulation times (ACT), hematocrit and creatinine were drawn at intervals before the start of CPB and then incrementally during UF (0, 2, 4 and 6 L removed). Hemodialysis (HD) was performed on one animal following UF. Results: Dabigatran concentration (ng/mL) rose from undetectable levels at baseline to 296±70 (pConclusions: UF in conjunction with CPB was ineffective at removing dabigatran. Heparin demonstrated a dabigatran-lowering effect, suggesting a possible drug interaction or assay impairment. Based on these findings, emergent cardiac surgery with UF on cardiopulmonary bypass to remove dabigatran is not advisable. Alternative forms of drug removal or reversal must be identified. |
| Databáze: | OpenAIRE |
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