Hemodialysis for removal of dabigatran in a patient with gastric hemorrhage. Issue 2 (30th June 2015)

• Record Type: Journal Article
• Authors: Kashiura, Masahiro; Fujita, Hiroshi; Sugiyama, Kazuhiro; Akashi, Akiko; Hamabe, Yuichi
• Is Part Of: Acute medicine & surgery. Volume 3:Issue 2(2016)
• Page Start: 132
• Page End: 134
• Publication Date: 2015-06-30
• Subjects: Anticoagulants -- dabigatran etexilate -- hemorrhage -- peptic ulcer perforation -- renal dialysis; Surgery -- Periodicals; Medical emergencies -- Periodicals; 617.005
• DOI: 10.1002/ams2.123
• Languages: English
• ISSNs: 2052-8817

Abstract

Abstract : Case: An 82‐year‐old man taking dabigatran was admitted with syncope. Computed tomography showed extravasation from the stomach. Laboratory data revealed renal insufficiency and prolonged activated partial thromboplastin time. The gastric endoscopy showed a gastric ulcer with an exposed vessel. However, an endoscopic hemostatic procedure failed to completely stop the bleeding. The patient experienced cardiac arrest from hypotensive shock. Spontaneous circulation returned after 5 min of resuscitation. After endoscopy, computed tomography showed a gastric perforation. For dabigatran removal, the patient underwent a 6‐h hemodialysis session. Thrombin activity and thrombin–antithrombin complex increased during hemodialysis, while activated partial thromboplastin time decreased. Outcome: Good recovery was observed after dialysis and the following gastrectomy. Conclusion: Hemodialysis should be considered for dabigatran removal in cases of life‐threatening hemorrhage. The thrombin–antithrombin complex may be useful for monitoring the plasma dabigatran level.