J Korean Soc Clin Toxicol.  2014 Dec;12(2):92-96.

Dabigatran Toxicity Secondary to Acute Kidney Injury

• Moon HH
• Lee SE
• Oh DJ
• Jo HB
• Kwon KH
• Kim YJ
• Kim KS
• Shin SJ

Abstract

Dabigatran is the first oral direct thrombin inhibitor approved by the US Food and Drug Administration (FDA) for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Because dabigatran is excreted mainly by the kidneys, serum levels of dabigatran can be elevated to a supratherapeutic range in patients with renal failure, predisposing to emergent bleeding. We describe the case of a 66-year-old man taking dabigatran 150 mg twice daily for atrial fibrillation and cerebral infarction who presented with hematochezia and disseminated intravascular coagulation. Laboratory evaluation showed a hemoglobin level of 6.3 g/dL, platelets of 138,000/mm3, activated partial thromboplastin time (aPTT) of 10?s, and an international normalized ratio (INR) of 8.17. Colonoscopy showed a bleeding anal fissure. Hemostasis was provided by hemoclips and packed red blood cells and fresh frozen plasma were transfused. Since then, there was no further hematochezia, however, bleeding including oral mucosal bleeding, hematuria, and intravenous site bleeding persisted. At presentation, his serum creatinine was 4.96 mg/dL (baseline creatinine, 0.9 mg/dL). Dabigatran toxicity secondary to acute kidney injury was presumed. Because acute kidney injury of unknown cause was progressing after admission, he was treated with hemodialysis. Fresh frozen plasma transfusion was provided with hemodialysis. At 15 days from admission, there was no further bleeding, and laboratory values, including hemoglobin, partial thromboplastin time, and prothrombin time were normalized. He was discharged without bleeding. After 2 months, he undergoes dialysis three times per week and no recurrence of bleeding has been observed.

Keyword

Dabigatran; Acute kidney injury; Disseminated intravascular coagulation; Hemodialysis

MeSH Terms

Acute Kidney Injury*
Aged
Atrial Fibrillation
Cerebral Infarction
Colonoscopy
Creatinine
Dabigatran
Dialysis
Disseminated Intravascular Coagulation
Embolism
Erythrocytes
Fissure in Ano
Gastrointestinal Hemorrhage
Hematuria
Hemorrhage
Hemostasis
Humans
International Normalized Ratio
Kidney
Partial Thromboplastin Time
Plasma
Prothrombin Time
Recurrence
Renal Dialysis
Renal Insufficiency
Stroke
Thrombin
United States Food and Drug Administration
Creatinine
Thrombin