Comparison of intermittent and continuous extracorporeal treatments for the enhanced elimination of dabigatran

AbstractContext. Severe bleeding associated with dabigatran frequently requires intensive care management. An antidote is currently unavailable and data reporting the effect of dialysis on elimination of dabigatran are encouraging, but limited. Objective. To report the effect of intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) at enhancing elimination of dabigatran. Materials and methods. Patients were identified by existing collaborative networks. Pre-filter dabigatran plasma concentrations were measured in all patients, and in dialysate of three patients. Results. Seven patients received dialysis, five with active bleeding and two requiring emergent surgery. Five received IHD and two received CRRT. The plasma elimination half-life of dabigatran was 1.5–4.9 h during IHD, and 14.0–27.5 h during CRRT. Mean dabigatran plasma clearance during IHD was 85–169 mL/min in three patients. Time to obtain a subtherapeutic dabigatran concentration depended on the initial concentration, ...