title: [Vaginal bleeding as symptom of a medical emergency--pitfalls of therapy with new oral anticoagulants - case 5/2014].
abstract: METHODS
  A 90-year-old female patient treated with dabigatran for atrial fibrillation presented emergently with a spontaneous vaginal bleeding due to endometrium carcinoma.
  
  
  METHODS
  Laboratory analysis revealed azotemia consistent with acute-on-chronic renal failure. Coagulation was deranged (prolongation of activated partial thromboplastin time (aPTT) by 3.5-fold, international normalized ratio (INR) 7.8) due to a massive accumulation of dabigatran (measured plasma concentration 2230 ng/ml).
  
  
  METHODS
  Vaginal bleedings were treated with external tamponade. Hemodialysis treatment was commenced due to uremia and dabigatran accumulation. Over night, the patient was dialysed with a SLED (sustained low efficiency dialysis) regimen. After volume resuscitation renal function promptly ensued indicating prerenal azotemia as a cause of renal failure. After two more hemodialysis sessions dabigatran concentrations were no longer detecable and this was paralleled by normalization of coagulation tests.
  
  
  CONCLUSIONS
  Dabigatran can accumulate massively during acute renal failure and evoke a life-threatening bleeding diathesis. Dabigatran can be removed with low efficient dialysis (such as SLED).
authors: Medizinische Klinik, Universitätsklinikum Tübingen.
authors: Dorothea
authors: D
authors: Baumann
authors: Medizinische Klinik, Universitätsklinikum Tübingen.
authors: Michael
authors: M
authors: Haap
authors: Frauenklinik, Universitätsklinikum Tübingen.
authors: Christos
authors: C
authors: Tsaousidis
authors: Frauenklinik, Universitätsklinikum Tübingen.
authors: Bernhard
authors: B
authors: Krämer
authors: Medizinische Klinik, Universitätsklinikum Tübingen.
authors: Jürgen
authors: J
authors: Schreieck
authors: Medizinische Klinik, Universitätsklinikum Tübingen.
authors: Karl
authors: K
authors: Jaschonek
authors: Medizinische Klinik, Universitätsklinikum Tübingen.
authors: Ingo
authors: I
authors: Rettig
authors: Medizinische Klinik, Universitätsklinikum Tübingen.
authors: Andreas
authors: A
authors: Peter
authors: Frauenklinik, Universitätsklinikum Tübingen.
authors: Diethelm
authors: D
authors: Wallwiener
authors: Medizinische Klinik, Universitätsklinikum Tübingen.
authors: Ferruh
authors: F
authors: Artunc
mesh_terms: D000369:Aged, 80 and over; D000991:Antithrombins / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D001562:Benzimidazoles / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D000069604:Dabigatran; D003937:Diagnosis, Differential; D004630:Emergencies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D008657:Metabolic Clearance Rate / Q000502:physiology; D014592:Uterine Hemorrhage / Q000139:chemically induced*; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D000991:Antithrombins; D001562:Benzimidazoles; D015091:beta-Alanine; D000069604:Dabigatran