Vitamin K which is a cofactor for the synthesis of clotting factors II, VII, IX and X (plus protein C and S), warfarin inhibits Vitamin K. In 1941 Karl Paul Link gave him his answer and the rodent killer was born. He wanted to know what had killed his cow. In his truck, he had also brought a dead heifer and some spoiled clover hay. In 1933 a farmer from Deer Park showed up unannounced at the School of Agriculture and walked into a professor’s laboratory with a milk can full of blood which would not coagulate. On a trivia note warfarin was invented with the help of the Wisconsin Alumni Research Foundation (WARF) and hence the origin of the name (-arin indicating the link with coumarin). This can make the approach to treatment difficult when considering the need for therapeutic anticoagulation and expert advice maybe required.
This case highlights the potential use of idarucizumab for the management of massive dabigatran overdoses.ĭabigatran idarucizumab nonvitamin K antagonist oral anticoagulants overdose reversal.Over anticoagulation is a common problem with warfarin and acute intoxication maybe in those with or without an anticoagulation requirement. The initially planned emergency hemodialysis was canceled. The administration of 5 g of intravenous idarucizumab promptly and completely reversed the anticoagulant activity of dabigatran as assessed by routine and specific coagulation assays (aPTT from to 75 to 26 s, PT from 26 to 11 s and diluted thrombin time from 92 to 27 s). Despite gastric lavage and administration of activated charcoal within two hours of drug intake, the activated partial thromboplastin time (aPTT) and prothrombin time (PT) remained prolonged.
We describe the use of idarucizumab in the management of a 68-year-old woman who was taking dabigatran 150 mg twice daily and ingested 125 capsules. It reverses the anticoagulant effect of dabigatran within minutes and is approved for the reversal of dabigatran during emergency situations. Idarucizumab is an antibody fragment that binds dabigatran with high affinity. The lack of an antidote is a concern in patients who overdose on dabigatran, even though the drug can be eliminated with hemodialysis. Dabigatran, an oral direct thrombin inhibitor, is increasingly used in place of warfarin.
An overdose of oral anticoagulants represents a challenging scenario for emergency physicians.
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