Dabigatran plasma levels, aPTT and thromboelastography in patients with AF: implications for allowing early non-elective surgical procedures
| Autor: | Georgios Anagnostou, Theodora Kostelidou, Sotirios Kaliampakos, Nikolaos Sourlas, Stamatis Makrygiannis, Athanasios Pipilis, Panagiotis Mallios, Georgios Tsakonas |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Renal function 030204 cardiovascular system & hematology Dabigatran 03 medical and health sciences 0302 clinical medicine Atrial Fibrillation medicine Humans Trough Concentration 030212 general & internal medicine Dosing Aged Aged 80 and over medicine.diagnostic_test business.industry Atrial fibrillation Hematology medicine.disease Thromboelastography Thrombelastography Coagulation Anesthesia Female Partial Thromboplastin Time Cardiology and Cardiovascular Medicine Elective Surgical Procedure business medicine.drug |
| Zdroj: | Journal of thrombosis and thrombolysis. 44(1) |
| ISSN: | 1573-742X |
| Popis: | According to current recommendations, patients on dabigatran should stop the drug 24-96 h before scheduled surgery. This may seem too long for non-elective cases. The aim of our study was to assess the number of patients on dabigatran who could theoretically undergo surgery 12 h post last drug dosing. We measured dabigatran plasma trough concentration by Hemoclot assay in 75 consecutive patients receiving dabigatran. Coagulation was assessed by aPTT and thromboelastography (TEG). Plasma levels ≤30 ng/ml were considered low. TEG parameters measured were clot reaction time (R), clot growth index (k), angle (α), maximal amplitude (MA) and the percentage of clot lysed after 30 min (LY30). Twelve patients (16%) had low plasma dabigatran levels 11.6 ± 0.9 h post last dosing. These patients compared to those with higher levels had significantly different aPTT (37.7 ± 4.4 vs. 49.6 ± 9.2 s; p 0.001) and TEG R (6.7 ± 1.3 vs. 8.4 ± 2.6 min; p = 0.002). Only three of the patients with low levels had an aPTT40 s. Within those with levels30 ng/ml, four patients (6.4%) had plasma dabigatran levels ≥200 ng/ml, all with aPTT65 s and TEG R11 min. When the analysis was restricted to patients with creatinine clearance80 ml/min, six (27.3%) had low plasma dabigatran levels. In this theoretical study, with a low risk population, it is suggested that one-sixth of patients receiving dabigatran have low drug concentrations at 12 h. Further studies are needed to confirm that such patients with low trough levels can actually undergo safely early surgery if necessary. |
| Databáze: | OpenAIRE |
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