title: What is the role of hemodialysis for dabigatran-associated major bleeding?
abstract: A 70-year-old male with a history of atrial fibrillation who is being anticoagulated with dabigatran etexilate presents to the emergency room with melena. He reports taking his most recent dose of dabigatran more than 2 hours ago. On examination, he is hypotensive and tachycardic, and he continues to have melanotic stools. Laboratory testing reveals a calculated creatinine clearance of 15 mL/min, a prothrombin time of 16.5 seconds (reference range: 11.8-15.2 seconds), an international normalized ratio of 1.2 (reference range: 0.9-1.2), and an activated partial thromboplastin time of 50 seconds (reference range: 22.2-33.0 seconds). You are asked by the emergency medicine physician whether hemodialysis should be considered to decrease the patient's plasma dabigatran level.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA; and.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kim
authors.affiliation: Division of Hematology, Department of Medicine, University of Washington, Seattle, WA.
authors.forename: David A
authors.initials: DA
authors.lastname: Garcia
mesh_terms: D000368:Aged; D001562:Benzimidazoles / Q000009:adverse effects*; D000069604:Dabigatran; D006470:Hemorrhage / Q000139:chemically induced* / Q000628:therapy*; D006801:Humans; D008297:Male; D064887:Observational Studies as Topic; D006435:Renal Dialysis; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D001562:Benzimidazoles; D015091:beta-Alanine; D000069604:Dabigatran