Extracorporeal treatment for digoxin poisoning: systematic review and recommendations from the EXTRIP Workgroup

Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists
James B MowryEXTRIP Workgroup

Abstract

The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatments (ECTR) in poisoning. Here, we present our results for digoxin. After a systematic literature search, clinical and toxicokinetic data were extracted and summarized following a predetermined format. The entire workgroup voted through a two-round modified Delphi method to reach a consensus on voting statements. A RAND/UCLA Appropriateness Method was used to quantify disagreement, and anonymous votes were compiled and discussed in person. A second vote was conducted to determine the final workgroup recommendations. Out of 435 articles screened, 77 met inclusion criteria. Only in-vitro, animal studies, case reports and case series were identified yielding a very low quality of evidence for all recommendations. Based on data from 84 patients, including six fatalities, it was concluded that digoxin is slightly dialyzable (level of evidence = B), and that ECTR is unlikely to improve the outcome of digoxin-toxic patients whether or not digoxin immune Fab (Fab) is administered. Despite the lack of robust clinical evidence, the workgroup recommended against the use of ECTR in cases of severe digoxin p...Continue Reading

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Citations

May 10, 2018·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Marie DeguigneBénédicte Lelièvre
Sep 22, 2018·Drug and Chemical Toxicology·Sa'ed H ZyoudWaleed M Sweileh
Apr 6, 2019·British Journal of Hospital Medicine·Roberta CallusLara Delicata
Aug 2, 2018·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Thomas F Whayne
Apr 14, 2020·Seminars in Dialysis·Bethany RoehmDaniel E Weiner
Jun 18, 2020·BMJ Case Reports·Lara DelicataJohn Bonello
Nov 24, 2020·Annals of Intensive Care·Bruno MégarbaneCharles Cerf
Feb 9, 2021·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Anselm WongUNKNOWN EXTRIP workgroup
Feb 21, 2021·Drug and Therapeutics Bulletin·Lara DelicataJohn Bonello
Jan 22, 2019·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Vijoy Kumar Jha, K V Padmaprakash
Mar 5, 2021·Pharmacotherapy·James B MowryUNKNOWN Extracorporeal Treatments in Poisoning workgroup

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