Dabigatran Toxicity Secondary to Acute Kidney Injury.
- Author:
Hyoung Ho MOON
1
;
Seung Eun LEE
;
Dong Jun OH
;
Hee Bum JO
;
Ki Hwan KWON
;
Yoon Jin KIM
;
Kyung Soo KIM
;
Sung Joon SHIN
Author Information
1. Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Go-yang, Korea. shine@duih.org
- Publication Type:Case Report
- Keywords:
Dabigatran;
Acute kidney injury;
Disseminated intravascular coagulation;
Hemodialysis
- MeSH:
Acute Kidney Injury*;
Aged;
Atrial Fibrillation;
Cerebral Infarction;
Colonoscopy;
Creatinine;
Dabigatran;
Dialysis;
Disseminated Intravascular Coagulation;
Embolism;
Erythrocytes;
Fissure in Ano;
Gastrointestinal Hemorrhage;
Hematuria;
Hemorrhage;
Hemostasis;
Humans;
International Normalized Ratio;
Kidney;
Partial Thromboplastin Time;
Plasma;
Prothrombin Time;
Recurrence;
Renal Dialysis;
Renal Insufficiency;
Stroke;
Thrombin;
United States Food and Drug Administration
- From:Journal of The Korean Society of Clinical Toxicology
2014;12(2):92-96
- CountryRepublic of Korea
- Language:English
-
Abstract:
Dabigatran is the first oral direct thrombin inhibitor approved by the US Food and Drug Administration (FDA) for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Because dabigatran is excreted mainly by the kidneys, serum levels of dabigatran can be elevated to a supratherapeutic range in patients with renal failure, predisposing to emergent bleeding. We describe the case of a 66-year-old man taking dabigatran 150 mg twice daily for atrial fibrillation and cerebral infarction who presented with hematochezia and disseminated intravascular coagulation. Laboratory evaluation showed a hemoglobin level of 6.3 g/dL, platelets of 138,000/mm3, activated partial thromboplastin time (aPTT) of 10?s, and an international normalized ratio (INR) of 8.17. Colonoscopy showed a bleeding anal fissure. Hemostasis was provided by hemoclips and packed red blood cells and fresh frozen plasma were transfused. Since then, there was no further hematochezia, however, bleeding including oral mucosal bleeding, hematuria, and intravenous site bleeding persisted. At presentation, his serum creatinine was 4.96 mg/dL (baseline creatinine, 0.9 mg/dL). Dabigatran toxicity secondary to acute kidney injury was presumed. Because acute kidney injury of unknown cause was progressing after admission, he was treated with hemodialysis. Fresh frozen plasma transfusion was provided with hemodialysis. At 15 days from admission, there was no further bleeding, and laboratory values, including hemoglobin, partial thromboplastin time, and prothrombin time were normalized. He was discharged without bleeding. After 2 months, he undergoes dialysis three times per week and no recurrence of bleeding has been observed.
