Thursday, April 26, 2012

Q: 60 year old male with ESRD (End Stage Renal Disease), and with history of A. Fib. is recently started on Pradaxa (Dabigatran). Patient presented with acute lower GI bleed. Patient took last dose about 12 hours ago. Knowing that reversal for Pradaxa is not available to you, what could be your option here? 

Answer: Hemodialysis (HD) 

Though Hemodialysis may not be fully effective but upto 60% of Dabigatran can be removed via hemodialysis and may provide some relief. Patient with already available access for HD should be given advantage of it with close volume monitoring and replacement. 

 For patients with creatinine clearance (CrCl) more than 30 mL/min, the recommended dose of PRADAXA is 150 mg twice daily. For patients with severe renal impairment (CrCl 15-30 mL/min), the recommended dose of PRADAXA is 75 mg twice daily.

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