Key result
Inappropriate dabigatran in end-stage renal failure triggers severe bleeding that standard idarucizumab may not reverse.
Case Report (n=1)
In patients with end-stage renal failure, the standard 5-g dose of idarucizumab may be insufficient to permanently reverse dabigatran, highlighting the potential need for repeated administration to prevent rebound bleeding.
Warrants caution with dabigatran in renal failure; leaves open optimal idarucizumab redosing for refractory hemorrhage.
A 72-year-old man with end-stage renal failure, receiving 220 mg of dabigatran for chronic atrial fibrillation, was admitted with generalized edema and shortness of breath. Cardiac tamponade caused by pericardial hemorrhage due to inappropriate dabigatran use was treated with pericardial drainage and idarucizumab. Although coagulability normalized, consecutive duodenal hemorrhages occurred, requiring arterial embolization for hemostasis. In cases of severely impaired renal function, the usual dose of idarucizumab may not be sufficient to reverse the effects of dabigatran. Therefore, we considered the need for repeated idarucizumab administration to prevent recurrent bleeding.
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Hayashida et al. (2024) conducted a case report in End-stage renal failure and chronic atrial fibrillation (n=1). Dabigatran was evaluated. Inappropriate use of dabigatran in a patient with end-stage renal failure led to cardiac tamponade and duodenal hemorrhage, suggesting that standard doses of idarucizumab may be insufficient for reversal.
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