Abstract
Dabigatran is a direct oral anticoagulant thrombin inhibitor approved for stroke prophylaxis
in patients with non-valvular atrial fibrillation and prophylaxis or treatment of
venous thromboembolism. Since approval, there has been increasing concern regarding
bleeding risk, predominantly in the elderly population and those with renal disease.
We present a case of an 85-year-old female with an unknown medication history, shortness
of breath and severe anemia due to an upper gastrointestinal bleed. Laboratory abnormalities
were significant for INR 6.43 and serum creatinine 2.21 mg/dL. While in the emergency
department the patient decompensated requiring intubation, aggressive crystalloid
resuscitation, blood products and initiation of vasopressors. The inability to distinguish
between warfarin- and dabigatran-induced coagulopathies paired with the lack of medical
information complicated selection of the appropriate anticoagulation reversal agent.
In an attempt to prevent a prothrombotic state, prothrombin complex concentrates (PCC)
were held and reversal was accomplished with idarucizumab alone, although warfarin-induced
coagulopathy remained a possibility. 30 min after administration, repeat PT/INR was
16.1 s and 1.55, respectively. It was later confirmed that the patient was on sole
dabigatran therapy.
This case highlights the potential for dabigatran to cause extreme elevation in PT/INR
in patients with acute renal failure, which may mimic warfarin-induced coagulopathy.
Further, it demonstrates significant, rapid correction of abnormal coagulation assays
following administration of idarucizumab in a patient with severe INR elevation and
suspected dabigatran use.
Keywords
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Article Info
Publication History
Published online: February 05, 2021
Accepted:
January 27,
2021
Received in revised form:
January 26,
2021
Received:
December 20,
2020
Publication stage
In Press Journal Pre-ProofFootnotes
☆No professional assistance or other paid/non-paid manuscript writers/supporters.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
