This correspondence, published in Blood in March, was probably pretty easy to overlook.
A patient enrolled in RE-LY, the trial comparing dabigatran and warfarin for non-valvular atrial fibrillation, underwent open aortic valve replacement surgery. As instructed, he discontinued his dabigatran two days prior to the surgery.
Had a little bit of a bleeding problem.
After 26 units of RBCs, 5 packs of platelets, 22 units of FFP, 5 x 10 units of cryoprecipitate, two doses of protamine, two doses of tranexamic acid, and five doses of Factor VIIa, the patient was finally stable enough to be evacuated to the ICU for dialysis to remove the remaining dabigatran.
What’s most fabulously ironic about this correspondence is that the authors use this horrifying case to sprightly conclude Factor VIIa and hemodialysis are viable and effective reversal strategies for dabigatran-associated bleeding.
The patient – “The postoperative course was complicated by prolonged ventilation/Enterobacter pneumonia, asymptomatic nonocclusive femoral DVT (by surveillance ultrasonography [postoperative day (POD 7)]), and acute-on-chronic renal failure. Discharge to a rehabilitation facility occurred on POD56.” – probably disagrees.
Would you be surprised if I mentioned there’s a COI issue involving the authors and the manufacturer?
“Recombinant factor VIIa (rFVIIa) and hemodialysis to manage massive dabigatran-associated postcardiac surgery bleeding”
www.ncbi.nlm.nih.gov/pubmed/22383791