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Dabigatran etexilate: appropriate use in patients with chronic kidney disease and in the elderly patients
- Source :
- Internal and Emergency Medicine. 12:425-435
- Publication Year :
- 2017
- Publisher :
- Springer Science and Business Media LLC, 2017.
-
Abstract
- Dabigatran etexilate (DE) is a direct thrombin inhibitor, which has been approved for the treatment of non-valvular atrial fibrillation (AF), and for the prevention and treatment of venous thromboembolism (VTE). Despite large randomized clinical trials and independent observational studies providing robust data concerning DE safety and efficacy, some physicians still perceive mild-to-moderate renal impairment and old age as a relative contraindication to its use. In this article, we review the available scientific evidence supporting the use of DE in these clinical situations. Patients with AF and chronic kidney disease (CKD) are per se at high risk of stroke, bleeding and mortality. Although there is evidence of clinical benefit of anticoagulation in these patients, anticoagulant therapy requires caution and demands careful clinical monitoring, regardless of the drug used. In patients with no contraindication to its use, the clinical benefit of DE versus warfarin is independent of renal function. The elderly with AF are frequently undertreated because of the perception of high bleeding risk and limited clinical benefit. However, the clinical benefit of anticoagulation is independent of patient age, and age per se should not represent a contraindication to anticoagulation. DE has been extensively studied in the elderly, both in randomized clinical trials and in observational studies: DE 150 mg BID should not be used in patients 80 years of age or older, while DE 110 mg BID is as safe as warfarin. Intracranial haemorrhages reduction by DE compared with warfarin is preserved in the elderly. Therefore, mild and moderate CKD and being elderly should not deter physicians from prescribing DE. Furthermore, the availability of a specific antidote is expected to improve the safety of the use of DE in clinical practice.
- Subjects :
- medicine.medical_specialty
Metabolic Clearance Rate
Antithrombin
Hemorrhage
030204 cardiovascular system & hematology
Antithrombins
law.invention
Dabigatran
03 medical and health sciences
Elderly
0302 clinical medicine
Randomized controlled trial
law
Chronic kidney disease
Atrial Fibrillation
Internal Medicine
Humans
Medicine
030212 general & internal medicine
Renal Insufficiency, Chronic
Bleeding
Aged
Aged, 80 and over
Anticoagulants
Geriatrics
Warfarin
Emergency Medicine
Intensive care medicine
Contraindication
Stroke
business.industry
Anticoagulant
medicine.disease
Direct thrombin inhibitor
Observational study
business
Geriatric
Human
Kidney disease
medicine.drug
Subjects
Details
- ISSN :
- 19709366 and 18280447
- Volume :
- 12
- Database :
- OpenAIRE
- Journal :
- Internal and Emergency Medicine
- Accession number :
- edsair.doi.dedup.....17b8726e3456aad07feed876cad652b8
- Full Text :
- https://doi.org/10.1007/s11739-017-1660-6