Open AccessHemodialysis for removal of dabigatran in a patient with gastric hemorrhage
Author(s) -
Kashiura Masahiro,
Fujita Hiroshi,
Sugiyama Kazuhiro,
Akashi Akiko,
Hamabe Yuichi
Publication year - 2016
Publication title -
acute medicine and surgery
Language(s) - English
Resource type - Journals
ISSN - 2052-8817
DOI - 10.1002/ams2.123
Subject(s) - dabigatran , medicine , hemodialysis , intensive care medicine , atrial fibrillation , warfarin
Case An 82‐year‐old man taking dabigatran was admitted with syncope. Computed tomography showed extravasation from the stomach. Laboratory data revealed renal insufficiency and prolonged activated partial thromboplastin time. The gastric endoscopy showed a gastric ulcer with an exposed vessel. However, an endoscopic hemostatic procedure failed to completely stop the bleeding. The patient experienced cardiac arrest from hypotensive shock. Spontaneous circulation returned after 5 min of resuscitation. After endoscopy, computed tomography showed a gastric perforation. For dabigatran removal, the patient underwent a 6‐h hemodialysis session. Thrombin activity and thrombin–antithrombin complex increased during hemodialysis, while activated partial thromboplastin time decreased. Outcome Good recovery was observed after dialysis and the following gastrectomy. Conclusion Hemodialysis should be considered for dabigatran removal in cases of life‐threatening hemorrhage. The thrombin–antithrombin complex may be useful for monitoring the plasma dabigatran level.