Intravenous fat emulsion does not significantly alter clotting markers in dabigatran-treated blood [abstract #20]
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Background: Dabigatran etexilate is an oral direct thrombin (factor IIa) inhibitor that is Food and Drug Administration-approved to reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation and for the treatment and reduction of risk of deep vein thrombosis (DVT) and pulmonary embolism. Dabigatran offers several advantages over traditional treatment with warfarin, including but not limited to no routine laboratory monitoring. It has been shown to be equivalent in prevention of stroke and DVT with similar bleeding rates. Hemodialysis has been proposed as a method of reversal, but unfortunately there is no known reversal method appropriate for use in patients with emergent life threatening hemorrhage. Intravenous fat emulsion (IFE) has been used in the treatment of overdose of lipophilic drugs. Most toxicologists only recommend IFE for patients in extremis after ingestion of a lipid soluble substance. Dabigatran is lipidsoluble, particularly in pro-drug form. Research Question: Will IFE treatment correct in vitro dabigatran-induced coagulopathy of human blood samples? Methods: Blood draws from healthy volunteers were spiked with dabigatran or dabigatran plus IFE. Values for Ecarin clot time (ECT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) were compared across both study arms. Data were analyzed using paired ttests. Results: The study included 18 healthy volunteers. Addition of dabigatran caused a marked increase in ECT, INR, and PTT compared with untreated and samples treated only with IFE. There was no significant difference in the ECT between the dabigatran and dabigatran+IFE arms (see table). INR and aPTT were statistically significantly different between the two arms. Discussion: In vitro addition of IFE to dabigatran-treated samples did not significantly alter the ECT. The small decreases in INR and aPPT were statistically significant but unlikely to be clinically relevant. These data suggest IFE may not successfully reverse the effects of dabigatran. The major limitation of these studies is their in vitro nature. Conclusion: IFE does not reverse in vitro dabigatran-induced do-agulopathy.