Limitace účinnosti idarucizumabu při akutním renálním selhání – kazuistika
| Title in English | Limitations of idarucizumab efficacy in acute renal failure – a case report |
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| Authors | |
| Year of publication | 2023 |
| Type | Article in Periodical |
| Magazine / Source | Klinicka Farmakologie a Farmacie |
| MU Faculty or unit | |
| Citation | |
| Web | https://www.klinickafarmakologie.cz/pdfs/far/2023/02/08.pdf |
| Doi | http://dx.doi.org/10.36290/far.2023.015 |
| Keywords | dabigatran; idarucizumab; acute renal failure; efficacy; limits |
| Description | Idarucizumab, a monoclonal antibody fragment capable of binding dabigatran molecules in a 1 : 1 stoichiometric relationship, is a specific antidote for dabigatran. The dose of idarucizumab was estimated based on observed plasma concentrations of dabigatran to achieve immediate, complete, and sustained reversal of the anticoagulant effect of dabigatran. Currently, a single dose of 5 g intravenously is recommended. However, in certain situations, the capacity of idarucizumab may be exhausted, and dabigatran plasma concentrations may rise again within hours of initial administration. We illustrate one such situation with a patient with acute renal failure, where despite the administration of the second dose of idarucizumab, there was no sustained reversal of the effect of dabigatran. The availability of a specific antidote is an indisputable advantage of dabigatran over other direct anticoagulants. Its use needs to be critically evaluated in view of the limitations of its efficacy. This is especially true in patients with acute renal failure or very high plasma concentrations of dabigatran. |
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