title: Case report: dabigatran-associated gynecologic bleeding.
abstract: OBJECTIVE
  The case of a patient who experienced major gynecological bleeding after initiation of dabigatran therapy for atrial fibrillation is reported.
  
  
  CONCLUSIONS
  A 33-year-old Hispanic female with multiple medical problems presented to the emergency department (ED) with a 5-day history of menorrhagia and a 3-day history of dizziness, fatigue, and weakness. Prior to ED presentation, she had been initiated on dabigatran 150 mg twice daily for atrial fibrillation. Four days later, she began having profuse vaginal bleeding. She discontinued all of her home medications including dabigatran, and her bleeding subsided the next day. Upon presentation to the ED, her hemoglobin was 7.1 g/dL, for which she was transfused 2 units of packed red blood cells, increasing her hemoglobin to 9.6 g/dL. Because the patient was in atrial fibrillation, warfarin was initiated once she was clinically stable and she was never restarted on dabigatran. Her hemoglobin was stable throughout admission with no further bleeding. She was discharged on warfarin and closely followed without incident.
  
  
  CONCLUSIONS
  A 33-year-old Hispanic female with no pre-existing gynecologic abnormalities had a major gynecological bleed shortly after starting dabigatran that resolved after discontinuation.
authors.affiliation: PGY1 Pharmacy Resident, Harris County Hospital District, Houston, Texas.
authors.forename: S Alexander
authors.initials: SA
authors.lastname: Winans
authors.affiliation: Clinical Pharmacy Specialist, Emergency Medicine, Lyndon B. Johnson Hospital, Houston, Texas. Corresponding author: Adetola Ademolu, PharmD, BCPS, Harris County Hospital District, 5656 Kelley Street, Houston, Texas 77026; phone: 832-465-8143; e-mail: Adetola.Ademolu@harrishealth.org.
authors.forename: Adetola
authors.initials: A
authors.lastname: Ademolu
keywords: dabigatran; gynecologic bleed; major hemorrhage