title: Acute adrenal failure following anticoagulation with dabigatran after hip replacement and thrombolysis for massive pulmonary embolism.
abstract: A 75-year-old woman presented 9 days post-total hip replacement with sudden onset of shortness of breath and fever. She had been discharged taking dabigatran. The patient was treated for sepsis with antibiotics and fluids. However, she deteriorated and was transferred to the intensive care unit. Following a 10 s asystolic episode the patient was thrombolysed with alteplase for presumed massive pulmonary embolism. Initially, her blood pressure and oxygen saturation improved. However, over the next few days, she remained persistently hypotensive. A CT scan of her chest, abdomen and pelvis demonstrated bilateral adrenal haemorrhages. A short synacthen test confirmed acute adrenal failure.
authors: Department of Respiratory Medicine, High Wycombe Hospital, Buckinghamshire, UK.
authors: Martin
authors: M
authors: Best
authors: Kate
authors: K
authors: Palmer
authors: Quentin Christopher
authors: QC
authors: Jones
authors: Christopher G
authors: CG
authors: Wathen
mesh_terms: D000307:Adrenal Gland Diseases / Q000139:chemically induced / Q000150:complications; D000309:Adrenal Insufficiency / Q000209:etiology*; D000368:Aged; D000991:Antithrombins / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip; D001562:Benzimidazoles / Q000009:adverse effects*; D000069604:Dabigatran; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced / Q000150:complications; D006801:Humans; D011655:Pulmonary Embolism / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000991:Antithrombins; D001562:Benzimidazoles; D005343:Fibrinolytic Agents; D015091:beta-Alanine; D010959:Tissue Plasminogen Activator; D000069604:Dabigatran