Coagulopathy and Extremely Elevated PT/INR after Dabigatran Etexilate Use in a Patient with End-Stage Renal Disease
| Autor: | George S. Abela, Joonseok Kim, In Chul An, Venu Gourineni, Mrinal Yadava, Heather Laird-Fick, Abrar R Sayeed |
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| Rok vydání: | 2013 |
| Předmět: |
Prothrombin time
medicine.medical_specialty medicine.diagnostic_test business.industry medicine.medical_treatment lcsh:R lcsh:Medicine Case Report Atrial fibrillation General Medicine medicine.disease End stage renal disease Surgery Dabigatran Direct thrombin inhibitor Anesthesia medicine Hemodialysis business Stroke medicine.drug Partial thromboplastin time |
| Zdroj: | Case Reports in Medicine, Vol 2013 (2013) Case Reports in Medicine |
| ISSN: | 1687-9635 1687-9627 |
| DOI: | 10.1155/2013/131395 |
| Popis: | Introduction.Dabigatran is an oral direct thrombin inhibitor which has been approved for prophylaxis of stroke in patients with atrial fibrillation. The use of dabigatran etexilate increased rapidly due to many benefits. However, questions have been raised constantly regarding the safety of dabigatran etexilate.Case.A 58-year-old Caucasian male with a history of recurrent paroxysmal atrial fibrillation status after pacemaker and end-stage renal disease on hemodialysis came to the Emergency Department with the complaint of severe epistaxis. He had been started on dabigatran 150 mg twice a day about 4 months ago as an outpatient by his cardiologist. His prothrombin time (PT) was 63 seconds with international normalized ratio (INR) of 8.8 and his activated partial thromboplastin time (aPTT) was 105.7 seconds. Otherwise, all labs were unremarkable including the liver function test. Dabigatran was stopped immediately. His INR and aPTT trended downward, reaching normal levels 5 days after admission.Conclusion.Dabigatran is contraindicated in patients with severe kidney insufficiency as it is predominantly excreted via the kidney (~80%). Elderly patients over 75 and patients with chronic renal impairment should be carefully evaluated before starting dabigatran. Despite studies showing only mild increase in aPTT and PT/INR in patients receiving dabigatran, close monitoring may be reasonable in patients with renal insufficiency. |
| Databáze: | OpenAIRE |
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