Abstract
Recently the "new oral anticoagulants" (NOAC) are increasingly applied in the prevention of systemic embolization in patients with non-valvular atrial fibrillation and in the treatment of thromboembolic disease. There are three drugs available for this indication in the Czech Republic - direct thrombin inhibitor dabigatran (Pradaxa) and two inhibitors of FXa - rivaroxaban (Xarelto) and apixaban (Eliquis).
So far, only dabigatran has an available antidote for serious bleeding or the need for rapid treatment of coagulopathy. This is idarucizumab, brand name Praxbind.
The authors noted and analyzed the data from six patients receiving dabigatran, whose state of health necessitated antagonization of its effect by an antidote administration. They focused on medical history, especially the indication for anticoagulation therapy, the dosage, the presence of any risk factors for bleeding, renal function, etc.
The available data show that all of these patients had significant impairment of renal function before the start of therapy with dabigatran. Therefore they had an increased risk of overdose and subsequent bleeding.
It means that in these patients the choice of dabigatran for anticoagulant therapy was incorrect or the dose of it wasn't adequately reduced. So bleeding complications could have been prevented, or their severity mitigated.