Risks of treatment by dabigatran in seniors with chronic kidney desease

Czech version

Authors: MUDr. Homolková Slávka; MUDr. Jaroňová Darja; MUDr. Hrnčiariková Dana, Ph.D.
Authors‘ workplace: III. interní gerontometabolická klinika FN Hradec Králové
Published in: Geriatrie a Gerontologie 2020, 9, č. 2: 93-96
Category:

Dabigatran u starších pacientů s chronickým onemocněním ledvin představuje zvláštní výzvu. S progresí renální insuficience se zvyšuje účinek dabigatranu, kvůli prodloužené eliminaci stoupá jeho koncentrace v séru. Pacienti starší 75 let navíc vykazují vyšší hladiny léčiva, než mladší nemocní se stejnou dávkou. V geriatrii se často kombinují dva rizikové faktory – věk a renální insuficience. Souběh těchto dvou faktorů může způsobit obtížný odhad antikoagulačního účinku dabigatranu.

Overview

Dabigatran anticoagulation therapy in patients with chronic kidney disease can be challenging. Progress of renal insufficiendy leads to prolonged drug elimination and thus higher levels of dabigatran serum. In addition, patients over 75 years of age have higher levels of the drug in serum than younger patients using the same dose. In geriatrics, two risks factors are often combined – renal insufficiency and higher age. This combination may be difficult to estimate the anticoagulant effect of dabigatran.

Standard test to monitor dabigatran therapy is not available at the moment. howewer, activated thromboplastin time – a routine test that is commonly available – can be used to control adherence and compliance to dabigatran therapy. Frail geriatric patients are in a high risk of rapid dehydration, which corelates with progression of pre-existing renal insufficiency and thus accumulation of dabigatran.

Three case reports are presented, which indicate the need for more frequent inspections, individualization of the dose of this anticoagulant and multidisciplinary cooperation.

Keywords:

bleeding – seniors – dabigatran – chronic kidney diesease

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