title: Management of dabigatran-induced bleeding with continuous venovenous hemodialysis.
abstract: Dabigatran, a direct thrombin inhibitor, is increasingly used for stroke prevention in patients with non-valvular atrial fibrillation. Dabigatran has a stable pharmacokinetic profile with minimum drug interactions, and requires no routine laboratory evaluation to measure level of anticoagulation. This provides a huge advantage over warfarin, and has the potential to improve patient compliance. The disadvantages of dabigatran are the lack of a reversal agent to counter dabigatran-related bleeding and the absence of a widely available laboratory test that can quantify the extent of coagulopathy in dabigatran overdose. Hemodialysis can rapidly lower dabigatran levels and assist in controlling bleeding secondary to dabigatran overdose. However, in cases in which hemodynamic instability precludes the use of hemodialysis, alternative methods have to be utilized to control dabigatran-associated bleeding. Here we document a case of massive gastrointestinal bleeding secondary to dabigatran use that was successfully managed by continuous venovenous hemodialysis (CVVHD), along with supportive care with blood product transfusions. CVVHD reduces thrombin time and activated partial thrombin time, and causes a parallel decrease in amount of active bleeding. Finally, we show that compared to the rapid lowering of elevated thrombin time observed in hemodialysis, CVVHD requires several days to reduce thrombin time to normal range.
authors: Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Ave, MS 1150, Toledo, OH, 43614, USA, suman.paul@utoledo.edu.
authors: Suman
authors: S
authors: Paul
authors: Danae
authors: D
authors: Hamouda
authors: Rohini
authors: R
authors: Prashar
authors: Chiamaka
authors: C
authors: Mbaso
authors: Abdur
authors: A
authors: Khan
authors: Abdulmonam
authors: A
authors: Ali
authors: Sarthi
authors: S
authors: Shah
authors: Ragheb
authors: R
authors: Assaly
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000009:adverse effects*; D001780:Blood Coagulation Tests; D001803:Blood Transfusion; D000069604:Dabigatran / Q000009:adverse effects*; D062787:Drug Overdose / Q000097:blood / Q000150:complications / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000139:chemically induced* / Q000628:therapy*; D006801:Humans; D006435:Renal Dialysis / Q000379:methods*
chemical_list: D000991:Antithrombins; D000069604:Dabigatran
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