Morning Report: 6/26/2012

Today’s morning report is thanks to Dr. Willis!

 

Pradaxa: Dabigatran etexilate

 

Pharmacokinectics

-Max effect in 2-3 hours

-Excreted in 12-14 hours

-Renally excreted (80%)

-CrCl <30 prolonged excretion and elevated concentrations

-No P450 interaction. Low plasma protein binding

 

Dosing

-CrCl >30 150mg BID

-CrCl 15-30 75mg BID

 

Action

-Inhibits thrombin mediated conversion of fibrinogen to fibrin

-Acts on intrinsic and extrinsic pathways

 

Pradaxa vs Warfarin

-Better CVA risk reduction

-No levels

-Faster onset of action

-300mg BID dose of pradaxa more GI bleeding

-Significant amount of dyspepsia in pradaxa

 

Coag Testing

-PT insensitive, no INR

-PTT therapeutic is 2x nml, supratherapeutic 2-3x nml. 12 hours after dose is 1.5x nml

-Thrombin clotting time is most sensitive. But supratherapeutic doses exceed max measurement. No standardization.

 

Toxicity

-In vitro testing suggests charcoal works

-No significant data for reversal agents

-rVIIa: theoretical hemostasis by direct thrombin activation

-rat and in vitro studies

-aPCC: rat and ex vivo studies show significant reduction

-Dialysis: 62-68% reduction of action in small open label study

 

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The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital

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