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Summary
Use of digoxin antibodies to treat digoxin poisoning: a subanalysis of the DIGITOX study
August Supervía1-4, Santiago Nogué4, Francisca Córdoba3-5, Jordi Puiguriguer6, Antonio F. Caballero-Bermejo7, Andrea Martínez Baladrón8, Francisco Callado9, Victoria Lobo Antuña10, Elena Fuentes3,11, Valle Molina Samper12, Susana Vert3,13, Francisco Ruíz-Ruíz14, F. Javier Guijarro Eguinoa15, Beatriz Martín-Pérez16, Samuel Olmos3,17, Guillermo Burillo-Putze4,18, María Teresa Maza Vera8, Oriol Pallàs1,2, Benjamín Climent10, Maider Igartua Astibia12, Edith Gutiérrez7, Ana Ferrer Dufol4
Affiliation of the authors
1Servicio de Urgencias, Hospital del Mar, Barcelona, Spain. 2Unitat Funcional de Toxicologia del Parc de Salut Mar, Barcelona, Spain. 3Grup de Treball de Toxicologia de la SoCMUE (SoCMUETox). 4Fundación Española de Toxicología Clínica, Barcelona, Spain. 5Servicio de Urgencias, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain. 6Servicio de Urgencias, Hospital Son Espases, Mallorca, Spain. 7Hospital Puerta de Hierro, Majadahonda, Madrid, Spain. 8Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, Spain. 9Servicio de Urgencias, Unidad de Toxicología Clínica, Hospital Universitario de Burgos, Burgos, Spain. 10Consorci Hospital General Universitari, Valencia, Spain. 11Servicio de Urgencias, Hospital Universitari de Bellvitge, Barcelona, Spain. 12Servicio de Urgencias, Hospital Universitario de Navarra, Pamplona, Spain. 13Servicio de Urgencias, Hospital de Viladecans, Barcelona, Spain. 14Servicio de Urgencias, Hospital Clínico de Zaragoza, Spain. 15Servicio de Urgencias, Hospital La Paz, Madrid, Spain. 16Servicio de Urgencias y Unidad de Toxicología Clínica, Hospital Universitario Río Ortega, Valladolid, Spain. 17Servicio de Urgencias, Consorci Hospitalari Parc Taulí de Sabadell, Barcelona, Spain. 18Universidad Europea de Canarias, Facultad de Ciencias de la Salud, Tenerife, Spain.
DOI
Quote
Supervía A, Nogué S, Córdoba F, Puiguriguer J, Caballero-Bermejo AF, Martínez Baladrón A, Callado F, Lobo Antuña V, Fuentes E, Molina Samper V, Vert S, Ruíz-Ruíz F, Guijarro Eguinoa FJ, Martín-Pérez B, Olmos S, Burillo-Putze G, Maza Vera MT, Pallàs O, Climent B, Igartua Astibia M, Gutiérrez E, Ferrer Dufol A. Use of digoxin antibodies to treat digoxin poisoning: a subanalysis of the DIGITOX study. Rev Esp Urg Emerg. 2024;3:90–5
Summary
BACKGROUND AND OBJECTIVE. Digoxin toxicity accounts for a small percentage of poisonings attended by emergency departments. This study aimed to evaluate whether treatment with digoxin-Fab (digoxin-specific antibody fragments) was used appropriately.
MATERIAL AND METHODS. Retrospective, observational, multicenter study in 15 hospital emergency departments in 8 Spanish autonomous communities over 7 years. We collected patient, clinical and treatment variables, and discharge destination. Patients were classified as having received digoxin-Fab treatment or not, and the decision to treat was evaluated as appropriate or not. We also assessed whether patients who were not treated with digoxin-Fab could have been.
RESULTS. Thirty-four of the 658 patients (5.2%) were treated with digoxin-Fab. The indication cited most often was the presence of bradycardia, particularly atrial fibrillation with a slow ventricular response. The next most common indication was a finding of a high digoxin concentration (> 6 ng/mL). For 33 of the 624 patients who did not receive digoxin-Fab treatment (5.3%), we later identified an indication that would have justified treatment, usually a high digoxin concentration (> 6 ng/mL) 6 hours after the last digoxin dose (in 31 patients). Three of the 33 patients (18.2%) who could have received digoxin-Fab treatment died; among the 34 patients who were treated, 4 died (11.8%) (P < .001).
CONCLUSIONS. Digoxin-Fab was administered to about 5% of patients with digoxin poisoning. At least an additional 5% of digoxin-poisoned patients could have benefited from treatment. Mortality was higher in untreated patients for whom treatment would have been indicated.
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