American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists · 2025
Use of thrombin time to transition from dabigatran to intravenous unfractionated heparin in patients with acute kidney injury.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Barakeh Donna, Donahue Kevin R, Sabawi Mahmoud, Dreucean Diane
Аннотация
PURPOSE: This case series explores the use of thrombin time (TT) to transition 2 patients from dabigatran to unfractionated heparin (UFH) in the setting of acute kidney injury (AKI) and coagulopathy concerning for dabigatran accumulation.
SUMMARY: Serial TT monitoring was employed until the value began to trend below 120 seconds, indicating ongoing drug clearance, at which point UFH was initiated. Patient 1 experienced rectal bleeding following initiation of UFH, while patient 2 experienced hemoglobin drops without an apparent bleeding source. No thrombotic events occurred during either hospitalization.
CONCLUSION: Individualized management remains paramount to balance bleeding and thrombotic risk based on patient-specific factors. Further research is warranted to validate the safety and efficacy of a TT-guided transition strategy and optimize protocols for hospitalized patients transitioning from dabigatran to UFH.
SUMMARY: Serial TT monitoring was employed until the value began to trend below 120 seconds, indicating ongoing drug clearance, at which point UFH was initiated. Patient 1 experienced rectal bleeding following initiation of UFH, while patient 2 experienced hemoglobin drops without an apparent bleeding source. No thrombotic events occurred during either hospitalization.
CONCLUSION: Individualized management remains paramount to balance bleeding and thrombotic risk based on patient-specific factors. Further research is warranted to validate the safety and efficacy of a TT-guided transition strategy and optimize protocols for hospitalized patients transitioning from dabigatran to UFH.