Letter to the Editor
Guided reversal of dabigatran in massive hemorrhagic shock: A case report
Reversión guiada de dabigatrán en un caso de shock hemorrágico masivo
Read
Not available
Timeswas read the article
Total PDF
Total HTML
Share statistics
array:22 [ "pii" => "S2173572724002431" "issn" => "21735727" "doi" => "10.1016/j.medine.2024.10.002" "estado" => "S200" "fechaPublicacion" => "2024-10-25" "aid" => "2086" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "copyrightAnyo" => "2024" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:18 [ "pii" => "S021056912400305X" "issn" => "02105691" "doi" => "10.1016/j.medin.2024.08.005" "estado" => "S200" "fechaPublicacion" => "2024-10-09" "aid" => "2086" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Reversión guiada de dabigatrán en un caso de shock hemorrágico masivo" "tienePdf" => "es" "tieneTextoCompleto" => "es" "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Guided reversal of dabigatran in massive hemorrhagic shock: A case report" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 922 "Ancho" => 3175 "Tamanyo" => 274986 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Resultado de los test viscoelásticos (ClotPro®) bajo los efectos de dabigatrán. EX-test: vista del proceso de coagulación tras la activación de la vía extrínseca. IN-test: prueba de cribado de la vía intrínseca de la coagulación. FIB-test: detección de fibrinógeno funcional. AP-test: prueba EX-test con inhibición de la fibrinólisis para confirmar la actividad hiperfibrinolítica. HI-test: prueba IN-test con adición de heparinasa para confirmar la presencia de heparina. ECA-test: prueba específica para antagonistas directos de la trombina (poco afectado por las heparinas o por antagonistas directos del factor X activado (FXa). RVV-test: prueba específica para antagonistas directos del FXa.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A5 y A10: amplitud a los 5 y 10 minutos tras el CT; CFT: tiempo de formación del coágulo; CT: tiempo de coagulación; MCF: firmeza máxima del coágulo; (mm): amplitud del coágulo en milímetros; (s): tiempo en segundos.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Manuel Fernández Caro, Manuel Casado_Méndez, Francisco Javier Rodríguez Martorell, Antonio Manuel Puppo Moreno" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Manuel" "apellidos" => "Fernández Caro" ] 1 => array:2 [ "nombre" => "Manuel" "apellidos" => "Casado_Méndez" ] 2 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Rodríguez Martorell" ] 3 => array:2 [ "nombre" => "Antonio Manuel" "apellidos" => "Puppo Moreno" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572724002431" "doi" => "10.1016/j.medine.2024.10.002" "estado" => "S200" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572724002431?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021056912400305X?idApp=WMIE" "url" => "/02105691/unassign/S021056912400305X/v1_202410091023/es/main.assets" ] ] "itemAnterior" => array:17 [ "pii" => "S2173572724000274" "issn" => "21735727" "doi" => "10.1016/j.medine.2024.02.003" "estado" => "S200" "fechaPublicacion" => "2024-02-25" "aid" => "1976" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Fractional excretion of sodium and potassium and urinary strong ion difference in the evaluation of persistent AKI in sepsis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Excreción fraccional de sodio y potasio, y brecha aniónica urinaria en la evaluación de la IRA persistente en sepsis" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1448 "Ancho" => 1675 "Tamanyo" => 110835 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0135" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">ROC curve showing the area under de curve of FENa, FEK and uSID.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">FENa: fractional excretion of sodium; FEK: fractional excretion of potassium; uSID: urinary strong ion difference.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nicolás Contrera Rolón, Joaquín Cantos, Iván Huespe, Eduardo Prado, Griselda I. Bratti, Carlos Schreck, Sergio Giannasi, Guillermo Rosa Diez, Carlos F. Varela" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Nicolás" "apellidos" => "Contrera Rolón" ] 1 => array:2 [ "nombre" => "Joaquín" "apellidos" => "Cantos" ] 2 => array:2 [ "nombre" => "Iván" "apellidos" => "Huespe" ] 3 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Prado" ] 4 => array:2 [ "nombre" => "Griselda I." "apellidos" => "Bratti" ] 5 => array:2 [ "nombre" => "Carlos" "apellidos" => "Schreck" ] 6 => array:2 [ "nombre" => "Sergio" "apellidos" => "Giannasi" ] 7 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Rosa Diez" ] 8 => array:2 [ "nombre" => "Carlos F." "apellidos" => "Varela" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572724000274?idApp=WMIE" "url" => "/21735727/unassign/S2173572724000274/v1_202402251056/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Guided reversal of dabigatran in massive hemorrhagic shock: A case report" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Manuel Fernández Caro, Manuel Casado Méndez, Francisco Javier Rodríguez Martorell, Antonio Manuel Puppo Moreno" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Manuel" "apellidos" => "Fernández Caro" "email" => array:1 [ 0 => "mfercar@outlook.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Manuel" "apellidos" => "Casado Méndez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Francisco Javier" "apellidos" => "Rodríguez Martorell" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Antonio Manuel" "apellidos" => "Puppo Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "UGC de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "UGC de Hematología, Sección de Hemostasia y Trombosis, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reversión guiada de dabigatrán en un caso de shock hemorrágico masivo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 922 "Ancho" => 3175 "Tamanyo" => 283485 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Result of viscoelastic testing (ClotPro®) under the effects of dabigatran. <span class="elsevierStyleBold">EX-test</span>: view of the coagulation process after activation of the extrinsic pathway. <span class="elsevierStyleBold">IN-test</span>: screening test of the intrinsic coagulation pathway. <span class="elsevierStyleBold">FIB-test</span>: detection of functional fibrinogen. <span class="elsevierStyleBold">AP-test</span>: EX-test with the inhibition of fibrinolysis to confirm hyper-fibrinolytic activity. <span class="elsevierStyleBold">HI-test</span>: IN-test with the addition of heparinase to confirm the presence of heparin. <span class="elsevierStyleBold">ECA-test</span>: specific test for direct thrombin antagonists (scantly affected by heparins or direct activated factor X (FXa) antagonists). <span class="elsevierStyleBold">RVV-test</span>: specific test for direct FXa antagonists. <span class="elsevierStyleBold">Parameters:</span> CT: clotting time; A5 and A10: amplitude 5 and 10 min after CT; CFT: clot formation time; MCF: maximum clot firmness. Time in seconds (s). Clot size in millimeters (mm).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Thromboembolic events are a major public health problem. Current clinical practice guidelines preferentially recommend direct oral anticoagulants (DOACs) as the preferred choice for preventing or treating such events in patients with atrial fibrillation or venous thromboembolic disease.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Dabigatran, a direct thrombin inhibitor, is increasingly being used due to its advantages over vitamin K antagonists, including a lower risk of intracranial bleeding, fixed dosing without the need for laboratory monitoring or dietary restrictions, few drug-drug interactions, and a faster onset and offset of pharmacological effects, which makes it easier to plan for invasive procedures.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Patients on DOACs may suffer severe bleeding or need urgent surgery and require a diagnosis with immediate treatment to reverse the anticoagulant effect. As conventional tests take too long to provide results, viscoelastic testing (VET), which is performed in whole blood and provides results in a few minutes, could prove to be very useful if specific techniques for the detection of DOACs (at levels >50 ng/mL) based on activation with ecarin for anti-IIa (ECA-test®) or with Russell viper venom for anti-Xa (RVV‑test®) are included.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 62-year-old woman was admitted to the hospital because of a reduced level of consciousness. On arrival at the emergency department, her blood pressure was 80/55 mmHg, and an endoscopy confirmed diffuse bleeding of the gastric mucosa, with a hemoglobin concentration of 4 g/dl on admission. The VET-guided massive transfusion protocol for hemostatic resuscitation was activated, with the transfusion of four units of packed red blood cells and 600 mL of plasma, which failed to control the bleeding. The patient was taking dabigatran at home, so we decided to extend the study with a specific dabigatran test (ECA-Test®), which confirmed a strong anticoagulant effect of the drug (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). We also measured specific dabigatran levels with the HemosIL® test, which showed a concentration 6 times higher than the upper reference limit (1287 ng/mL; reference limit < 200 ng/mL). The bleeding was finally controlled after three doses of idarucizumab each: the first dose one hour after onset of the symptoms and the remaining doses every 1–2 h (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), followed by clinical improvement. Despite bleeding control, the patient died of nosocomial pneumonia after a torpid course in intensive care. The RE‑VERSE AD study concluded that idarucizumab, a monoclonal antibody with high affinity and specificity for dabigatran, quickly and effectively reverts the anticoagulant effect of the latter drug following a single dose.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Its use is rarely needed, except in cases of potentially fatal bleeding or emergent surgery.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However, in the present case, repeated dosing guided by laboratory tests proved necessary due to the overdosing of dabigatran.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In conclusion, specific VET provides high sensitivity and specificity in detecting the presence of dabigatran in blood, justifying the use of antidotes, although the use of specific quantitative tests in plasma allows more efficient guidance of administration, as in our case, where the drug was rapidly and specifically detected - confirming the causative agent and the need for idarucizumab.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Author contributions</span><p id="par0020" class="elsevierStylePara elsevierViewall">All the authors contributed to the study conception and design (MFC, MCM, FJRM, AMPM), data acquisition (MFC, MCM, FJRM) or analysis and interpretation of the data (MCM, FJRM), and critical review of the intellectual content (MCM, FJRM, AMPM). All the authors approved the final version of the manuscript submitted for publication.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Author contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:2 [ "identificador" => "xack784152" "titulo" => "Acknowledgements" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 922 "Ancho" => 3175 "Tamanyo" => 283485 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Result of viscoelastic testing (ClotPro®) under the effects of dabigatran. <span class="elsevierStyleBold">EX-test</span>: view of the coagulation process after activation of the extrinsic pathway. <span class="elsevierStyleBold">IN-test</span>: screening test of the intrinsic coagulation pathway. <span class="elsevierStyleBold">FIB-test</span>: detection of functional fibrinogen. <span class="elsevierStyleBold">AP-test</span>: EX-test with the inhibition of fibrinolysis to confirm hyper-fibrinolytic activity. <span class="elsevierStyleBold">HI-test</span>: IN-test with the addition of heparinase to confirm the presence of heparin. <span class="elsevierStyleBold">ECA-test</span>: specific test for direct thrombin antagonists (scantly affected by heparins or direct activated factor X (FXa) antagonists). <span class="elsevierStyleBold">RVV-test</span>: specific test for direct FXa antagonists. <span class="elsevierStyleBold">Parameters:</span> CT: clotting time; A5 and A10: amplitude 5 and 10 min after CT; CFT: clot formation time; MCF: maximum clot firmness. Time in seconds (s). Clot size in millimeters (mm).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(#): The dabigatran levels in blood before the 1st dose of the antidote were not analyzed. INR: International normalized ratio. APTT: Activated partial thromboplastin time.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Before 1st dose \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Before 2nd dose \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Before 3rd dose \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">After 3rd dose \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dabigatran (ng/mL)(30–225) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"># \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1287 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">269.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">APTT-ratio (0.75–1.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.94 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">APTT (s)(24.8–37.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">143.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">126.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">105.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">INR(0.75–1.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.97 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3700960.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Evolution of massive bleeding and severe coagulopathy testing after repeated dosing of idarucizumab 5 g.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "When direct oral anticoagulants should not be standard treatment: JACC state-of-the-art review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Bejjani" 1 => "C.D. Khairani" 2 => "A. Assi" 3 => "G. Piazza" 4 => "P. Sadeghipour" 5 => "A.H. Talasaz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2023.10.038" "Revista" => array:5 [ "tituloSerie" => "Am Coll Cardiol" "fecha" => "2024" "volumen" => "83" "paginaInicial" => "444" "paginaFinal" => "465" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety of dabigatran as an anticoagulant: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Zhou" 1 => "Z. Yao" 2 => "L. Zhu" 3 => "Y. Tang" 4 => "J. Chen" 5 => "J. Wu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3389/fphar.2021.626063; 626063" "Revista" => array:3 [ "tituloSerie" => "Front Pharmacol" "fecha" => "2021" "volumen" => "12" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prospective observational study of the rapid detection of clinically-relevant plasma direct oral anticoagulant levels following acute traumatic injury" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Oberladstätter" 1 => "W. Voelckel" 2 => "C. Schlimp" 3 => "J. Zipperle" 4 => "B. Ziegler" 5 => "O. Grottke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/anae.15254" "Revista" => array:6 [ "tituloSerie" => "Anaesthesia" "fecha" => "2021" "volumen" => "76" "paginaInicial" => "373" "paginaFinal" => "380" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32946123" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idarucizumab for dabigatran reversal - full cohort analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.V. Pollack Jr." 1 => "P.A. Reilly" 2 => "J. van Ryn" 3 => "J.W. Eikelboom" 4 => "S. Glund" 5 => "R.A. Bernstein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1707278" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2017" "volumen" => "377" "paginaInicial" => "431" "paginaFinal" => "441" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28693366" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multidisciplinary consensus document on the management of massive haemorrhage. First update 2023 (document HEMOMAS-II)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.V. Llau" 1 => "C. Aldecoa" 2 => "E. Guasch" 3 => "P. Marco" 4 => "P. Marcos-Neira" 5 => "P. Paniagua" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medine.2023.05.006" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva (Engl Ed)" "fecha" => "2023" "volumen" => "47" "paginaInicial" => "454" "paginaFinal" => "467" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37536911" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack784152" "titulo" => "Acknowledgements" "texto" => "<p id="par0035" class="elsevierStylePara elsevierViewall">Thanks are due to Dr. José Garnacho-Montero, Dr. Ángel Herruzo-Avilés and Dr. Esteban Fernández-Hinojosa for their contribution to the final review of the manuscript.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/unassign/S2173572724002431/v1_202410250423/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/21735727/unassign/S2173572724002431/v1_202410250423/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572724002431?idApp=WMIE" ]
