What a neurosurgeon should know about dabigatran ???

Dr. Subhayan Mandal

MBBS, MS, MCh (NEUROSURGERY)
subhayanmandal@gmail.com
 AS THE OPINIONS AND MEDICINES FAIL
LIVES TASTE THE SUFFERINGS OF HAIL
IT’S NEUROWISH, KNOWLEDGE AND SURGEON’S SCALPEL
BRING THE HAPPINESS UNVEIL

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subhayanmandal@gmail.com
 Dabigatran in Neurosurgeons’ knowledge cognition level

EXECUTIVENESS IN TERMS OF PHARMACOKINETICS & PHARMACODYNAMICS

ELEGANCY OF USAGE

SIDE EFFECTS IN NEUROSURGICAL PERSPECTIVE

FUTURE DIRECTIONS …OFF THE LABEL USAGE

OPERATE NICELY A PATIENT WITH THE MOLECULE…….THE HOLISTICS

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subhayanmandal@gmail.com
subhayanmandal@gmail.com
 ELEGANCY OF DOSING………………………..

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 MECHANISTIC PLAUSIBILITY OF USAGE EVEN IN
HAEMOPHILLIAC

Warfarin Dabigatran Rivaroxaba Apixaban Edoxaban

(Coumadin®) (Pradaxa®) (Xarelto®) (Eliquis®) (Savaysa®)

Anticoagulant Anticoagulant Anticoagulant

Anticoagulant Anticoagulant
Drug Class (vitamin K (direct thrombin (factor Xa inhibitor)
(factor Xa inhibitor) (factor Xa inhibitor)
antagonist) inhibitor)

Selective inhibition Selective inhibition Selective inhibition

of factor Xa of factor Xa of factor Xa
Depletes vitamin K Reversible direct
Mechanism
inhibiting factors II, thrombin inhibitor
of Action
VII, IX, X (PRODRUG)

subhayanmandal@gmail.com
subhayanmandal@gmail.com
subhayanmandal@gmail.com
subhayanmandal@gmail.com
 Supremacy albeit less side effects..

Report of meta-analysis…………
o Source of data from
I. Medline Ovid (1946 to Oct.2015)
II. Embrace Ovid (1980-Oct 2015 )
III. Cochrane Central Register of Control Trial (CENTRAL, Issue 92015 )

o Oral anticoagulants are more effective than anti-platelelet agents in

reducing ischaemic stroke
o Compared to warfarin dabigatran reduces risk of al strokes
o Some novel oral anticoagulants – Dabigatran, Apixaban, Edoxaban in
compare to warfarin have less chances of major bleeding

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subhayanmandal@gmail.com
 Can be continued in ischaemic stoke with recent
micro-haemorrhagic conversion?????

Yes

Yes

Yes
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subhayanmandal@gmail.com
subhayanmandal@gmail.com
 Use of Dabigatran in peri-operative period….

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subhayanmandal@gmail.com
 Concommitant rtPA with Reversal agent???

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 Dabigatran …off label usage

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subhayanmandal@gmail.com
 Dabigatran and vascular dementia

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 Dabigatran and vascular dementia

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 Dabigatran and MS

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 Dabigatran and MS

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 There are BUTS…….

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 Takehome message

subhayanmandal@gmail.com
subhayanmandal@gmail.com
subhayanmandal@gmail.com
subhayanmandal@gmail.com
subhayanmandal@gmail.com
subhayanmandal@gmail.com
subhayanmandal@gmail.com
subhayanmandal@gmail.com
subhayanmandal@gmail.com
subhayanmandal@gmail.com
subhayanmandal@gmail.com
subhayanmandal@gmail.com