title: Dabigatran anticoagulation and Stanford type A aortic dissection: lethal coincidence: Case report with literature review.
abstract: BACKGROUND
  Novel oral anticoagulants are now encountered in patients needing emergency surgery. Knowledge and treatment options are limited.
  
  
  RESULTS
  We present the case of a 76-year-old patient who suffered from an acute Stanford type A aortic dissection, needing emergency surgical aortic repair. He was anticoagulated with dabigatran due to past atrial fibrillation. Despite haemodiafiltration, surgical revision and massive transfusion of packed red blood cells, fresh frozen plasma, platelets, coagulation factors, and recombinant factor VIIa, the patient died from intractable bleeding with sustained therapeutic levels of dabigatran.
  
  
  CONCLUSIONS
  After reviewing the literature, we summarize the limited treatment options and show possible approaches for patients treated with dabigatran needing emergency surgery.
authors.affiliation: Institute of Anaesthesiology, University and University Hospital of Zurich, Zurich, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Stein
authors.forename: M
authors.initials: M
authors.lastname: Bosshart
authors.forename: B
authors.initials: B
authors.lastname: Brand
authors.forename: A
authors.initials: A
authors.lastname: Schlicker
authors.forename: D R
authors.initials: DR
authors.lastname: Spahn
authors.forename: D
authors.initials: D
authors.lastname: Bettex
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000150:complications* / Q000601:surgery / Q000628:therapy; D000925:Anticoagulants / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000601:surgery / Q000628:therapy; D001022:Aortic Valve Insufficiency / Q000150:complications; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D001562:Benzimidazoles / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D001780:Blood Coagulation Tests; D016913:Blood Component Transfusion; D002305:Cardiac Tamponade / Q000209:etiology / Q000601:surgery; D002315:Cardiopulmonary Bypass; D000069604:Dabigatran; D004630:Emergencies; D017809:Fatal Outcome; D019918:Heart Valve Prosthesis Implantation; D017583:Hemodiafiltration; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications; D017379:Hypertrophy, Left Ventricular / Q000150:complications; D008297:Male; D011725:Pyridines / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D012771:Shock, Hemorrhagic / Q000139:chemically induced / Q000188:drug therapy / Q000209:etiology*; D013916:Thrombelastography; D014148:Tranexamic Acid / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D001779:Blood Coagulation Factors; D011725:Pyridines; D014148:Tranexamic Acid; D006493:Heparin; D000069604:Dabigatran