Abstract:
BACKGROUND:Incomplete reversal with a recommended 5-g dose of idarucizumab has been reported in patients with excessively high dabigatran concentrations. A timely detection of reversal failure after idarucizumab using whole blood (WB) coagulation testing is clinically useful. The aims of this study were to determine residual dabigatran activity after idarucizumab on thrombin generation (TG) using in vitro supratherapeutic dabigatran models and to compare 4 WB point-of-care tests (activated partial thromboplastin time [aPTT], prothrombin time [PT], and 2 thromboelastometry tests) with the TG results. METHODS:Blood samples from 12 healthy volunteers were spiked in vitro with 0-5000 ng/mL of dabigatran. Dabigatran reversal was evaluated by adding 1000 μg/mL of idarucizumab (Praxbind) to dabigatran-spiked samples, which reflect the administration of 5-g idarucizumab to a 70-kg patient. Residual dabigatran activity was assessed using the calibrated automated TG (Thrombinoscope) in platelet-poor plasma samples. The TG results were compared with WB aPTT (DRIHEMATO APTT-S) and PT (DRIHEMATO PT-S) using CG02N analyzer, thromboelastometry (ROTEM) triggered by ellagic acid (INTEM) and tissue factor (EXTEM). RESULTS:At a therapeutic concentration of dabigatran (200 ng/mL), the lag time was prolonged, and peak TG was decreased. The effects of dabigatran on TG were increased up to 1000 ng/mL, and TG was obliterated at higher supratherapeutic dabigatran levels (P < .001 versus control, respectively). TG was fully restored with idarucizumab when dabigatran was ≤2000 ng/mL, but residual anticoagulant activity was observed at higher dabigatran levels. Dabigatran prolonged WB aPTT and PT concentration dependently, and residual prolongations were observed when idarucizumab was added to 3000 or 5000 ng/mL of dabigatran (P < .001 versus control, respectively). In contrast, both INTEM and EXTEM clotting times were reversed toward reference ranges at all dabigatran concentrations when idarucizumab was added. CONCLUSIONS:Our data indicate that the recommended dose of idarucizumab may not restore TG completely with excessively elevated concentrations of dabigatran. All WB measurements with aPTT, PT, and thromboelastometry predicted supratherapeutic dabigatran concentrations, whereas those tests varied in sensitivity to residual anticoagulant activity after reversal. WB aPTT corresponded well with plasma TG changes among those measurements, but the use of thromboelastometry may overestimate the effect of idarucizumab. Caution should be exercised before extrapolating in vitro point-of-care data to the clinical monitoring of dabigatran reversal.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Takeshita S,Tanaka KA,Sawa T,Sanda M,Mizobe T,Ogawa Sdoi
10.1213/ANE.0000000000004419subject
Has Abstractpub_date
2020-02-01 00:00:00pages
535-541issue
2eissn
0003-2999issn
1526-7598journal_volume
130pub_type
杂志文章abstract:UNLABELLED:Intrathecal (IT) sufentanil provides effective analgesia for extracorporeal shock wave lithotripsy. However, the optimal dose of sufentanil has not been established. We designed a prospective, randomized, double-blinded study to determine the optimal dose of IT sufentanil. Sixty men were randomized to receiv...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199910000-00013
更新日期:1999-10-01 00:00:00
abstract:BACKGROUND:Improved pain control after cesarean delivery remains a challenging objective. Poorly treated acute pain following delivery is associated with an increased risk of chronic pain and depression. This study was conducted to determine whether the addition of systemic acetaminophen and an increased dose of intrat...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000000695
更新日期:2016-04-01 00:00:00
abstract:UNLABELLED:We compare hemodynamic responses in normotensive and hypertensive anesthetized paralyzed patients among three intubation devices: the Macintosh laryngoscope (LS), the Trachlight lightwand (LW), and the intubating laryngeal mask airway Fastrach (ILM). Seventy-five normotensive and 75 hypertensive patients wer...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/01.ane.0000048706.15720.c9
更新日期:2003-03-01 00:00:00
abstract:BACKGROUND:Atelectasis occurs regularly after induction of general anesthesia, persists postoperatively, and may contribute to significant postoperative morbidity and additional health care costs. Laparoscopic surgery has been reported to be associated with an increased incidence of postoperative atelectasis. It has be...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0b013e3181ba7945
更新日期:2009-11-01 00:00:00
abstract:UNLABELLED:To evaluate the influence of needle type on the lateral distribution of 0.5% hyperbaric bupivacaine, 30 patients undergoing lower limb surgery were placed in the lateral position with the side to be operated on dependent and underwent dural puncture by either a 25-gauge Whitacre (n = 15) or a 25-gauge Quinck...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199808000-00022
更新日期:1998-08-01 00:00:00
abstract::Lidocaine catabolism under N2O anesthesia was evaluated in 5 dogs given a lidocaine infusion of 2 mg/kg/min for 20 minutes. Comparison of results with those of a prior similar study with halothane to be significantly faster in the animals given N2O. The extraction ratio for lidocaine, which did not vary with its arter...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-197605000-00007
更新日期:1976-05-01 00:00:00
abstract::The management of postoperative nausea and vomiting (PONV) remains a persistent problem. Despite the use of prophylactic antiemetics, breakthrough nausea and vomiting still frequently occur. There have been no published studies comparing dolasetron and ondansetron for the treatment of PONV. This was a prospective, ran...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/01.ANE.0000144421.96275.D1
更新日期:2005-02-01 00:00:00
abstract::We have recently reported a chronic allodynialike symptom in rats after ischemic spinal cord injury. This pain-related behavior is resistant to a number of pharmacologic treatments, including morphine, clonidine, carbamazepine, baclofen, and muscimol. In the present report, we present evidence indicating that systemic...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199205000-00005
更新日期:1992-05-01 00:00:00
abstract::We studied the effect of intravenous (IV) thiamylal or ketamine on the increases in serum myoglobin, creatine kinase (CK), and potassium induced by succinylcholine under halothane anesthesia. Ninety patients were divided into three groups. In Group O, succinylcholine (1.0 mg/kg) was administered after an the inhaled i...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199511000-00021
更新日期:1995-11-01 00:00:00
abstract:UNLABELLED:We determined the effects of fentanyl, sufentanil, morphine, and meperidine on the spontaneous contractility of isolated human pregnant uterine muscle strips. Uterine specimens were obtained from normal full-term parturients undergoing elective lower-segment cesarean delivery. Longitudinal muscle strips were...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200104000-00037
更新日期:2001-04-01 00:00:00
abstract:UNLABELLED:We studied the effect of fluvoxamine and erythromycin on the pharmacokinetics of ropivacaine in a double-blinded, randomized, four-way cross-over study. Eight healthy volunteers ingested daily 1500 mg erythromycin for 6 days, 100 mg fluvoxamine for 5 days (Days 2-6), both erythromycin and fluvoxamine, or pla...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200011000-00030
更新日期:2000-11-01 00:00:00
abstract:BACKGROUND:Pathophysiologic changes in children with congenital heart disease may alter the effect of drugs by influencing the pharmacokinetics (PK). Considering the limited literature that describes the PK of etomidate in pediatric patients, especially in those with tetralogy of Fallot (TOF), our aim was to characteri...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000001477
更新日期:2016-09-01 00:00:00
abstract:BACKGROUND:Visual estimation and gravimetric methods are commonly used to quantify the volume of blood loss during cesarean delivery (CD). However, the correlation between blood loss and post-CD hemoglobin (Hb) is poorly studied, and it is unclear whether the correlation varies according to how blood loss is measured. ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000003449
更新日期:2019-05-01 00:00:00
abstract::The primary outcome of this 8-year retrospective review was the failure of spinal anesthetic (SA) in elective hip and knee joint arthroplasty surgery. Of 3542 SAs, a total of 135 failures were identified (3.8%). Factors associated with increased odds of failure were younger age (odds ratio [OR], 1.03; 95% confidence i...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究
doi:10.1213/ANE.0000000000004304
更新日期:2020-01-01 00:00:00
abstract:UNLABELLED:Nonsteroidal antiinflammatory drugs (NSAIDs) provide effective postoperative analgesia after arthroscopic knee surgery. Some investigators have suggested that the preemptive administration of NSAIDs may reduce postoperative analgesic requirements and hypersensitivity. We evaluated the analgesic effect of adm...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200201000-00010
更新日期:2002-01-01 00:00:00
abstract::Rapid sequence induction and intubation (RSII) and awake tracheal intubation are commonly used anesthetic techniques in patients at risk of pulmonary aspiration of gastric or esophageal contents. Some of these patients may have a gastric tube (GT) placed preoperatively. Currently, there are no guidelines regarding whi...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0b013e3182917f11
更新日期:2014-03-01 00:00:00
abstract::A 7-year-old girl manifested the rare anomaly of a ventricular septal defect (VSD) with left aortic arch, right descending aorta, and right ligamentum arteriosum. After open-heart surgery to correct the VSD, symptoms of tracheal obstruction on spontaneous breathing developed, due to tracheal compression by the right l...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1976-07-01 00:00:00
abstract:UNLABELLED:Patients undergoing vascular surgery have a high risk of suffering major postoperative cardiac events. Preoperative myocardial ischemia as detected by Holter monitoring identifies a high-risk subgroup whose postoperative ischemia, similarly detected, seems to herald major cardiac events. In this study, we de...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199903000-00002
更新日期:1999-03-01 00:00:00
abstract::Aprotinin, a potent antifibrinolytic drug, reduces the proportion of adults who receive blood transfusions during cardiac surgery, although the effect in children remains unclear. We performed a systematic review of the literature to identify all English language, randomized controlled trials of aprotinin involving ch...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,meta分析
doi:10.1213/01.ane.0000194954.64293.61
更新日期:2006-03-01 00:00:00
abstract:UNLABELLED:The nonhalogenated anesthetic alkanes, cyclopropane and butane, do not enhance gamma-aminobutyric acid-elicited GABAergic currents, suggesting that these agents produce anesthesia via interactions with other molecular targets. Perhalogenated nonimmobilizing alkanes, such as 1,2-dichlorohexafluorocyclobutane ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200209000-00015
更新日期:2002-09-01 00:00:00
abstract:BACKGROUND:Nicotine has an antinociceptive effect in animal models. The analgesic effect in humans has been examined, but studies have had mixed results. A proposed etiology is variability in chronic nicotine exposure because of differences in tobacco smoking rates and second-hand smoke exposure. In this study, we exam...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0b013e3181bd1612
更新日期:2009-12-01 00:00:00
abstract::The purpose of this study was to determine whether preoperative screening of pediatric patients, accomplished by means of a preoperative telephone call to their parents, would decrease the rate of cancellation or postponement of ambulatory surgical procedures. Data from 5031 patients scheduled for ambulatory surgery w...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199208000-00018
更新日期:1992-08-01 00:00:00
abstract:BACKGROUND:Platelet factor 4 (PF4) is released by activated platelets and has a strong affinity for heparin. Recombinant PF4 (rPF4) has been previously considered as an alternative to protamine for heparin reversal. However, it has been demonstrated that antibodies directed against the PF4/heparin moiety are important ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3182662e1a
更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:Calmodulin (CaM) activation by Ca(2+), its translocation to the nucleus, and stimulation of phosphorylation of cyclic adenosine monophosphate response element-binding protein (CREB) (P-CREB) are necessary for new gene expression and have been linked to long-term potentiation, a process important in memory fo...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181b5a1b8
更新日期:2009-10-01 00:00:00
abstract::Anecdotal reports suggest that soda lime and Baralyme brand absorbent can degrade inhaled anesthetics to carbon monoxide (CO). We examined the factors that govern CO production and found that these include: 1) The anesthetic used: for a given minimum alveolar anesthetic concentration (MAC)-multiple, the magnitude of C...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199506000-00021
更新日期:1995-06-01 00:00:00
abstract::Implanted electronic medical devices. or stimulators such as pacemakers and nerve stimulators have grown enormously in diversity and complexity over recent decades. The function and potential interaction of these devices with the perioperative environment is of increasing concern for anesthesiologists and surgeons. Be...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0000000000001983
更新日期:2017-07-01 00:00:00
abstract:UNLABELLED:Postoperative pain is a common reason for the delayed discharge and unanticipated hospital admission of out-patients. In this study, we examined the pattern of pain in ambulatory surgical patients and determined those factors that predict postoperative pain. Ten thousand eight consecutive ambulatory surgical...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199710000-00017
更新日期:1997-10-01 00:00:00
abstract::Virchow's triad is traditionally invoked to explain pathophysiologic mechanisms leading to thrombosis, alleging concerted roles for abnormalities in blood composition, vessel wall components, and blood flow in the development of arterial and venous thrombosis. Given the tissue-specific bleeding observed in hemophilia ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0b013e31823a088c
更新日期:2012-02-01 00:00:00
abstract::Because of its slow onset of action, intrathecal morphine may not be the optimal drug for intraoperative analgesia during short cases, such as cesarean sections. It is not known whether adding fentanyl to a morphine-lidocaine spinal solution would provide any benefits to patients undergoing cesarean sections. Sixty-tw...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/00000539-199405000-00014
更新日期:1994-05-01 00:00:00
abstract:UNLABELLED:Volatile anesthetics attenuate baroreflex function in a concentration-dependent manner. This study was designed to determine how long full recovery of baroreflex control of heart rate takes after isoflurane or sevoflurane anesthesia in healthy volunteers. We assessed baroreflex sensitivity in 20 subjects ran...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200111000-00012
更新日期:2001-11-01 00:00:00