title: Promise and challenges of anticoagulation with dabigatran.
abstract: Dabigatran, marketed as Pradaxa (Boehringer Ingelheim) in the USA, is a direct thrombin inhibitor that holds great promise. It has been shown to reduce the risk of stroke and venous thromboembolism with similar if not greater efficacy than warfarin and with far fewer side effects. However, like other anticoagulants, it can cause severe bleeding complications and lacks a specific antidote with proven efficacy. The patient presented here was on dabigatran and sustained a traumatic intracranial hemorrhage (ICH). The ICH continued to progress despite prompt initiation of 3h of hemodialysis in an effort to remove the offending drug from the circulation. Through this case report, we highlight the challenges of anticoagulation with dabigatran including the lack of routine testing for monitoring its effect and of a specific antidote. We also discuss the potential role of dialysis in treating patients with life-threatening bleeding on dabigatran.
authors: Division of Renal Medicine , University of Massachusetts Medical School , Worcester, MA , USA.
authors: Ashish
authors: A
authors: Verma
authors: Department of Transfusion Medicine , University of Massachusetts Medical School , Worcester, MA , USA.
authors: Vishesh
authors: V
authors: Chhibber
authors: Department of Trauma Surgery & Surgical Critical Care , University of Massachusetts Medical School , Worcester, MA , USA.
authors: Timothy
authors: T
authors: Emhoff
authors: Division of Renal Medicine , University of Massachusetts Medical School , Worcester, MA , USA.
authors: Dagmar
authors: D
authors: Klinger
keywords: bleeding; dabigatran; dialysis