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
Leave your thoughts below.
Jay Khadpe MD
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