The Elective Rotation: A Critical Care Hospital Pharmacy Podcast

Show notes at pharmacyjoe.com/episode30. In this episode I’ll 1. Discuss some cases of using IV lipid emulsion for drug toxicity 2. List which patient care areas in my institution are stocked with IV lipid emulsion 3. Review the dosing of IV lipid emulsion

Show notes at pharmacyjoe.com/episode29. In this episode I will: 1. Review an article about idarucizumab for dabigatran reversal 2. Answer a drug information question: “Can I use rivaroxaban to treat a pulmonary embolism (PE) in a patient with active cancer?” 3. Share a resource I use that is a collection of evidence based critical care [...]

In this episode I will:

1. Review an article about idarucizumab for dabigatran reversal
2. Answer a drug information question: "Can I use rivaroxaban to treat a pulmonary embolism (PE) in a patient with active cancer?"
3. Share a resource I use that is a collection of evidence based critical care guidelines

Article

Idarucizumab for Dabigatran Reversal

Lead author:  Charles V. Pollack

Published in New England Journal of Medicine (NEJM) August 6, 2015

Background

Idarucizumab for dabigatran reversal is in the news again since the FDA approved the drug on October 16, 2015.  This article is interim analysis of an ongoing study of idarucizumab (RE-VERSE AD). It was this study that the FDA based its approval of idarucizumab for dabigatran reversal.

Purpose

To determine the effects of idarucizumab, an antibody fragment, that was developed to reverse the anticoagulant effects of dabigatran.

Methods

The study is a prospective cohort study using 5 g of intravenous idarucizumab to reverse the anticoagulant effects of dabigatran in patients who had serious bleeding (group A) or required an urgent procedure (group B). The primary end point is the maximum percentage reversal of the anticoagulant effect of dabigatran within 4 hours after the administration of idarucizumab. A secondary end point is the restoration of hemostasis.

Results

This interim analysis included 90 patients who received idarucizumab (51 patients in group A and 39 in group B). Among 68 patients with an elevated dilute thrombin time and 81 with an elevated ecarin clotting time at baseline, the median maximum percentage reversal was 100%. Idarucizumab normalized the test results in 88 to 98% of the patients, an effect that was evident within minutes. Among 35 patients in group A who could be assessed, hemostasis, as determined by local investigators, was restored at a median of 11.4 hours. Among 36 patients in group B who underwent a procedure, normal intraoperative hemostasis was reported in 33, and mildly or moderately abnormal hemostasis was reported in 2 patients and 1 patient, respectively. One thrombotic event occurred within 72 hours after idarucizumab administration in a patient in whom anticoagulants had not been reinitiated.

Conclusion

The authors concluded that idarucizumab completely reversed the anticoagulant effect of dabigatran within minutes.

I checked with my purchasing pharmacist (thanks Mark!) - idarucizumab is now available via drop ship at a cost of $3500.

Temporary summary

Show notes at pharmacyjoe.com/episode28. In this episode I’ll share how I approach a “Pharmacy Pain Consult” at my hospital. I’ll discuss how I titrate opioid doses when the patient has risk factors for respiratory depression. I’ll also share the 4 most common fixes to inadequate pain management.

Temporary summary

Show notes at pharmacyjoe.com/episode27. In this episode I will: 1. Review an article about the choice of IV fluids in ICU patients 2. Answer a drug information question: “Have you seen dexmedetomidine drug fever?” 3. Share a free resource I use to stay updated with medical literature

Temporary summary

Show notes at pharmacyjoe.com/episode26. There are some interesting changes to the guidelines that pharmacists should know about and I’ll summarize them for you in this episode.

Show notes at pharmacyjoe.com/episode25. In this episode I ll talk about how to dose naloxone (Narcan) including when to give a lot and when to give just a little bit.