Dabigatran Plasma Levels in Acute Cerebrovascular Events

Area of Science:

• Pharmacology
• Neurology
• Nephrology

Background:

• Dabigatran is an effective oral anticoagulant for stroke prevention in nonvalvular atrial fibrillation, typically without requiring routine laboratory monitoring.
• Recent studies suggest a correlation between dabigatran plasma concentration (DPC) and ischemic stroke or bleeding events.
• Variability in DPC, influenced by factors like renal function, may complicate data interpretation and patient management.

Purpose of the Study:

• To investigate dabigatran plasma levels in patients experiencing acute cerebrovascular events.
• To explore the relationship between DPC and the type of acute cerebrovascular event (ischemic stroke vs. intracerebral hemorrhage).
• To assess the influence of renal function on DPC during acute events.

Main Methods:

• Retrospective analysis of consecutive patients with acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) on dabigatran.
• Dabigatran plasma concentration (DPC) measured on admission using diluted thrombin time.
• Creatinine clearance (CrCl) assessed via plasma and 24-hour urine creatinine measurements.

Main Results:

• Median DPC was significantly higher in ICH patients (135 ng/mL) compared to AIS patients (69.1 ng/mL) upon admission.
• Increased creatinine clearance (above normal range) correlated with lower median DPC (60 ng/mL) versus normal CrCl (100 ng/mL).
• Both decreased and increased renal function were found to significantly influence DPC.

Conclusions:

• Higher dabigatran plasma concentrations are associated with intracerebral hemorrhage compared to ischemic stroke in the acute phase.
• Renal function, both impaired and supra-normal, plays a critical role in determining dabigatran plasma levels.
• These findings highlight the importance of considering DPC and renal function in managing patients with cerebrovascular events on dabigatran.