Vladimir I. Kanjuh

Dabigatran - Metabolism, Pharmacologic Properties and Drug Interactions

BACKGROUND The superiority of dabigatran has been well proven in the standard dosing regimen in prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF) and extended venous thromboembolism (VTE) treatment. Dabigatran, an anticoagulant with a good safety profile, reduces intracranial bleeding in patients with atrial fibrillation and decreases major and clinically relevant non-major bleeding in acute VTE treatment. However, several important clinical issues are not fully covered by currently available directions with regard to dabigatran administration. The prominent one is reflected in the fact that dynamic impairment in renal function due to dehydratation may lead to haemorragic complications on the one hand, while on the other hand glomerular hyperfiltration may be a possible cause of dabigatran subdosing, hence reducing the drugs efficacy. Furthermore, limitations of the Cockcroft-Gault formula, considered a standard equation for assessing the renal function, may imply that other calculations are likely to obtain more accurate estimates of the kidney function in specific patient populations. Method and Conclusions: Although not routinely recommended, a possibility of monitoring dabigatran in special clinical settings adds to optimization of its dosage regimens, timely perioperative care and administration of urgently demanded thrombolytic therapy, therefore significantly improving this drugs safety profile. Despite the fact that dabigatran has fewer reported interactions with drugs, food constituents, and dietary supplements, certain interactions still remain, requiring considerable caution, notably in elderly, high bleeding risk patients, patients with decreased renal function and those on complex drug regimens. Additionally, upon approval of idarucizumab, an antidote to dabigatran solution, hitherto being a major safety concern, has been finally reached, which plays a vital role in life-threatening bleeding and emergency interventions and surgery.

Three-layered ventricular septum of the helical heart: functional anatomy and clinical relevance

Results IVS displays significant fiber disarray at the boundaries of LV and RV free walls, and contains an intriguing structure that may be freshly examined by the HVMB dissection. These dissections contradict the concept that the interventricular septum belongs to the LV, since both ventricles participate in its formation. Ascending and descending segments od the HVMB provide the origin and significance of mayor “septal fiber crossing”. Conventional low resolution ultrasound imaging of the ventricular septum previously identified the border of this crossing as hyperechogenic “septal line”. We suspect the overlap of the crossing of descending and ascending segments creates this “bright line”. Histological analyses have shown that septal RV and LV fibers create a connective tissue true space. Coronary artery septal branches run through this space, a fact, which may be useful in Ross’ procedure.