Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Dec. 17, 2010 Issue | Archived Issues

New Officers Elected for 2011

MEC Update

Christopher Ng, M.D., was elected for a second term as secretary of the medical staff and David Kulber, M.D., was elected as treasurer at the Dec. 6 Medical Executive Committee meeting. Also at the meeting, Chief of Staff Scott Karlan, M.D., announced that he has begun to send new Constitutional language to medical staff members for comment.

Morning After Report- December 2010


George Berci, M.D. ...

John Harold, M.D. ...

Prediman K. Shah, M.D. ...

Rick B. Delamarter, M.D. ...

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Reversal of Dabigatran's Effects

Pharmacy Focus

Dabigatran (Pradaxa®) is a new oral direct thrombin inhibitor approved in the U.S. for the prevention of stroke and systemic embolism in non-valvular atrial fibrillation patients.1 Over the past few weeks, there has been increased interest in this product and a growing number of inquiries regarding the management of these patients when anticoagulation needs to be reversed.

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Meetings and Events

The Drug Industry, Clinicians and Responsibility
Jan. 19

Advances in Nuclear Cardiology and Cardiac CT
Jan. 21-23

International Symposium on Pancreatic and Biliary Endoscopy
Jan. 28-30

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Reversal of Dabigatran's Effects

Pharmacy Focus

Dabigatran (Pradaxa®) is a new oral direct thrombin inhibitor approved in the U.S. for the prevention of stroke and systemic embolism in non-valvular atrial fibrillation patients.1 Over the past few weeks, there has been increased interest in this product and a growing number of inquiries regarding the management of these patients when anticoagulation needs to be reversed.

Unlike warfarin or heparin, routine coagulation monitoring is not required in patients receiving dabigatran. However, in the event that the anticoagulation effects of dabigatran are to be measured, the use of ecarin clotting time (ECT) is suggested. This currently is not available at Cedars-Sinai Medical Center.

Reversal of dabigatran, as needed in haemostatic emergencies, is challenging as there are no established agents available. For invasive surgeries or procedures, patient may require up to a five-day hold of dabigatran prior to the event. In patients with life-threatening bleeding, options that have been proposed based on limited non-clinical data included the use of rFVIIa and prothrombin complex concentrates (PCC). Limited data also suggests that removal of excess dabigatran may be achieved through dialysis or the use of activated charcoal (in overdose). Blood products may be used to maintain haemostasis, although they have not been shown to reverse the effects of dabigatran.2

References
1. Pradaxa [Package Insert]. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc.; 2010
2. van Ryn J, Stangier J, Haertter S, et al. Dabigatran etexilate – a novel, reversible, oral direct thrombin inhibitor: Interpretation of coagulation assays and reversal of anticoagulant activity. Thrombosis and Haemostatsis 2010; 103(6): 1116-27.