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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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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