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A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
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Dabigatran overload in acute kidney injury: haemodialysis or idarucizumab? A case report and proposal for a

Andrea Galassi1,2, Gianmarco Podda1,3, Paola Monciino1,2

  • 1Renal Division, Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, Italy.

Clinical Kidney Journal
|June 8, 2021
PubMed

Dabigatran overload has been reported in acute kidney injury (AKI), leading to occasional major bleeding. Haemodialysis (HD) was the method used for reversing dabigatran anticoagulant effects before the approval of idarucizumab, which is now indicated for dabigatran reversal in major bleeding or surgical emergencies. There have been reports of rebound of dabigatran levels following idarucizumab administration in AKI, requiring HD to achieve effective dabigatran clearance. However, a decisional algorithm to individualize treatments for dabigatran overload seems lacking. We present a case of dabigatran accumulation in obstructive AKI with minor bleeding that was successfully treated with HD and tranexamic acid without using idarucizumab, and propose a decision-making algorithm including different pathways in the management of suspected dabigatran overload in AKI.

Keywords:
acute kidney injurydabigatrandecision algorithmdialysisidarucizumab

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