title: Endometrial adenocarcinoma following supracervical hysterectomy managed with radiation due to dabigatran etexilate.
abstract: BACKGROUND
  Dabigatran etexilate, a new oral anticoagulant, has been developed for use in atrial fibrillation. This medication does not require therapeutic monitoring and there is no reversal agent in the event of life-threatening bleeding. We present a case of vaginal hemorrhage because of endometrial adenocarcinoma after a supracervical hysterectomy in a patient using dabigatran.
  
  
  METHODS
  74-year-old woman status after supracervical hysterectomy presented with profuse vaginal bleeding. Biopsy confirmed high-grade adenocarcinoma, suggesting endometrial origin. Because of recent use of dabigatran and vaginal bleeding she underwent treatment with full-dose radiation and brachytherapy.
  
  
  CONCLUSIONS
  Adenocarcinoma following supracervical hysterectomy is a rare occurrence. In the presence of profuse bleeding because of an anticoagulant with no reversal agents and extended activity, alternate modalities may be used.
authors.affiliation: Department of Obstetrics and Gynecology, Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, WA 98431.
authors.forename: Samit A
authors.initials: SA
authors.lastname: Patel
authors.affiliation: Department of Obstetrics and Gynecology, Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, WA 98431.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Goodrich
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000209:etiology* / Q000532:radiotherapy; D000368:Aged; D001562:Benzimidazoles / Q000009:adverse effects* / Q000627:therapeutic use; D000069604:Dabigatran; D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000532:radiotherapy; D065427:Factor Xa Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D049268:Positron-Emission Tomography; D011725:Pyridines / Q000009:adverse effects* / Q000627:therapeutic use; D020266:Radiotherapy, Conformal; D014057:Tomography, X-Ray Computed; D014592:Uterine Hemorrhage / Q000188:drug therapy*
chemical_list: D001562:Benzimidazoles; D065427:Factor Xa Inhibitors; D011725:Pyridines; D000069604:Dabigatran