title: Dabigatran overdose: a case report of acute hepatitis. Extracorporeal treatment.
abstract: Dabigatran is an oral, direct thrombin inhibitor approved by international regulatory agencies for stroke prevention in patients with paroxysmal or persistent non-rheumatic atrial fibrillation (AF). The benefits of dabigatran are widely described, but its use in the geriatric population is not without risk. Chronic kidney disease is a common comorbidity with AF, and thus frequent checks of renal function in elderly patients are recommended. We report a case of dabigatran intoxication in an elderly man affected by heart failure and worsening renal function, who developed acute hepatitis and coma, which was successfully treated with continuous veno-venous hemodiafiltration. Although extracorporeal therapy has been suggested as a strategy for clearing dabigatran during acute bleeding, this approach may be useful in other dabigatran-related, life-threatening conditions, such as that described in this report.
authors.affiliation: Internal Medicine and Haemocoagulopathies Unit, Azienda Ospedaliero Universitaria (A.O.U.), Presidio "Duilio Casula", University of Cagliari, SS 554, Bivio per Sestu, 09042, Monserrato, Cagliari, Italy.
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Porru
authors.affiliation: Internal Medicine and Haemocoagulopathies Unit, Azienda Ospedaliero Universitaria (A.O.U.), Presidio "Duilio Casula", University of Cagliari, SS 554, Bivio per Sestu, 09042, Monserrato, Cagliari, Italy. amameli@medicina.unica.it.
authors.forename: Antonella
authors.initials: A
authors.lastname: Mameli
authors.affiliation: Internal Medicine and Haemocoagulopathies Unit, Azienda Ospedaliero Universitaria (A.O.U.), Presidio "Duilio Casula", University of Cagliari, SS 554, Bivio per Sestu, 09042, Monserrato, Cagliari, Italy.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Cianchetti
authors.affiliation: Intensive Care Unit, Azienda Ospedaliero Universitaria (A.O.U.), Presidio "Duilio Casula", University of Cagliari, Monserrato, Cagliari, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Musu
authors.affiliation: Internal Medicine and Haemocoagulopathies Unit, Azienda Ospedaliero Universitaria (A.O.U.), Presidio "Duilio Casula", University of Cagliari, SS 554, Bivio per Sestu, 09042, Monserrato, Cagliari, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Schirru
authors.affiliation: Internal Medicine and Haemocoagulopathies Unit, Azienda Ospedaliero Universitaria (A.O.U.), Presidio "Duilio Casula", University of Cagliari, SS 554, Bivio per Sestu, 09042, Monserrato, Cagliari, Italy.
authors.forename: Maria F
authors.initials: MF
authors.lastname: Ruberto
authors.affiliation: Internal Medicine and Haemocoagulopathies Unit, Azienda Ospedaliero Universitaria (A.O.U.), Presidio "Duilio Casula", University of Cagliari, SS 554, Bivio per Sestu, 09042, Monserrato, Cagliari, Italy.
authors.forename: Doris
authors.initials: D
authors.lastname: Barcellona
authors.affiliation: Internal Medicine and Haemocoagulopathies Unit, Azienda Ospedaliero Universitaria (A.O.U.), Presidio "Duilio Casula", University of Cagliari, SS 554, Bivio per Sestu, 09042, Monserrato, Cagliari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Marongiu
mesh_terms: D000208:Acute Disease; D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy; D003128:Coma / Q000139:chemically induced / Q000628:therapy; D000069604:Dabigatran / Q000633:toxicity*; D062787:Drug Overdose / Q000150:complications / Q000628:therapy*; D006333:Heart Failure; D017583:Hemodiafiltration; D006505:Hepatitis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D051436:Renal Insufficiency, Chronic; D020521:Stroke / Q000517:prevention & control
chemical_list: D000069604:Dabigatran
keywords: Acute hepatitis; Continuous veno-venous hemodiafiltration; Dabigatran etexilate; Overdose