title: Fatal basilar artery occlusion under dabigatran occurring 13 days after femoral embolectomy.
abstract: A male with atrial fibrillation for 30 years underwent embolectomy in his right leg at age 78 years. Postoperatively, he received enoxaparin 60 mg/twice a day (bid), and on day 5, phenprocoumon was started. The patient's son, a general practitioner, changed phenprocoumon to dabigatran 110 mg/bid on day 8. Pain in his left calf induced readmission after 5 days. International normalized ratio was 2.5 and D-dimer was 20 μg/mL. Dabigatran was stopped and dalteparin 5000 International Units/bid and 40 μg alprostadil infusions were started. After 8 hours, he became comatose due to basilar artery occlusion and eventually died. This tragic case raises the issue of postoperative use of dabigatran, a recently introduced thrombin inhibitor.
authors.affiliation: Krankenanstalt Rudolfstiftung, Juchgasse, Wien, Österreich. claudia.stollberger@chello.at
authors.forename: Claudia
authors.initials: C
authors.lastname: Stöllberger
authors.forename: Markus
authors.initials: M
authors.lastname: Reiter
authors.forename: Lilian
authors.initials: L
authors.lastname: Schäffl-Doweik
authors.forename: Josef
authors.initials: J
authors.lastname: Finsterer
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects*; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects*; D002533:Cerebral Angiography; D000069604:Dabigatran; D016903:Drug Monitoring / Q000379:methods; D004359:Drug Therapy, Combination; D017128:Embolectomy; D004617:Embolism / Q000209:etiology / Q000601:surgery*; D017984:Enoxaparin / Q000008:administration & dosage; D017809:Fatal Outcome; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D010644:Phenprocoumon / Q000008:administration & dosage; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D001562:Benzimidazoles; D017984:Enoxaparin; D015091:beta-Alanine; D000069604:Dabigatran; D010644:Phenprocoumon