title: Spontaneous splenic hemorrhage after initiation of dabigatran (Pradaxa) for atrial fibrillation.
abstract: Dabigatran etexilate (Pradaxa; Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT) is an oral anticoagulant that produces a reliable, dose-dependent anticoagulant effect without the need for routine laboratory monitoring. Dabigatran is a direct thrombin inhibitor, acting like other members in its class (bivalirudin, argatroban) to impede the clotting process through selective and reversible binding with both free and clot-bound thrombin. Dabigatran anticoagulates rapidly: plasma levels peak 2 hours after absorption, with a half-life that ranges between 12 and 17 hours. Dabigatran was approved by the Food and Drug Administration in October 2010 after it compared favorably with warfarin in a large clinical trial studying its efficacy in stroke prevention in atrial fibrillation. Currently, there is no laboratory test on the market by which a physician can quantify the anticoagulation effect of dabigatran, nor is there any antidote to reverse a life-threatening bleed should it occur. We present a case of a patient with splenic hemorrhagic soon after initiation of dabigatran.
authors.affiliation: Department of Emergency Medicine, George Washington University Medical Center, Washington, DC 20037, USA. charles-haviland.moore@aya.yale.edu
authors.forename: Charles Haviland
authors.initials: CH
authors.lastname: Moore
authors.forename: Jonathan
authors.initials: J
authors.lastname: Snashall
authors.forename: Keith
authors.initials: K
authors.lastname: Boniface
authors.forename: James
authors.initials: J
authors.lastname: Scott
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001562:Benzimidazoles / Q000009:adverse effects* / Q000627:therapeutic use; D000069604:Dabigatran; D004636:Emergency Service, Hospital; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D013158:Splenic Diseases / Q000139:chemically induced*; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D001562:Benzimidazoles; D015091:beta-Alanine; D000069604:Dabigatran