Case report: hemodialysis for dabigatran overdose

April 23, 2013, 7:22 pm

Pradaxa★★★☆☆

Hemodialysis for the Treatment of Pulmonary Hemorrhage from Dabigatran Overdose. Chen BC et al. Am J Kidney Dis 2013 Apr 15 [Epub ahead of print]

Abstract

Dabigatran (Pradaxa) is a competitive direct thrombin inhibitor approved in the United States for stroke prophylaxis in patients with nonvalvular atrial fibrillation. Although dabigatran has certain advantages over coumadin related to issues of dosing and testing, there is no readily available test to measure its anticoagulation effect, and there is no antidote to reverse bleeding.

Recommendations for treating a patient with dabigatran-associated hemorrhage include local control of bleeding, and hemodialysis (HD). Although dialysis may be difficult in a patient with critical bleeding — such as intracranial hemorrhage — this case report, from NYU and the NYC Poison Control Center, suggests that HD may be useful in some cases.

An 80-year-old man presented with hemoptysis and pulmonary hemorrhage. Increasing dyspnea required intubation and mechanical ventilation. History revealed that some dabigatran pills (150 mg) were missing from his supply. INR, aPTT, and thrombin time were all abnormal. The initial dabigatran level was 1,100 ng/ml, over 8 times therapeutic. The patient underwent 4 hours of HD. During dialysis his coagulation studies improved and pulmonary aspirates cleared. Dabigatran levels measured before, during, and after dialysis demonstrated significant drug clearance, although there was some rebound.

The source of hemorrhage was found to be a tuberculous lung abscess.

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