Key result
Idarucizumab promptly ceased bleeding in dabigatran intoxication, and cholestatic liver injury was identified as a possible rare side-effect of dabigatran treatment.
Case Report (n=1)
Idarucizumab effectively reverses dabigatran-induced bleeding, and Hemoclot dTT is useful for monitoring dabigatran levels in complex cases like sepsis, while cholestatic liver injury may be a rare side effect of dabigatran.
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May inform idarucizumab use in dabigatran intoxication; hypothesis-generating for rare cholestatic hepatotoxicity.
Idarucizumab, an antidote specific for dabigatran, became available recently. Dabigatran is not associated with increased risk of hepatotoxicity in comparison with warfarin, but it is seen as a rare side-effect. Cases of cholestatic liver injury due to dabigatran have not been reported previously. We present a case of severe gastro-intestinal bleeding with underlying dabigatran intoxication in a patient with renal failure and the effect of reversal of dabigatran using idaruzicumab on coagulation assays. International normalized ratio (INR) and activated partial thromboplastin time (APTT) results were elevated in a setting of sepsis, possibly due to liver failure. INR and APTT can be elevated if sepsis is complicated by disseminated intravascular coagulation (DIC) or liver failure, making it challenging to determine dabigatrans contribution to their prolongation. A rebound effect after administration of idarucizumab and slow elimination of dabigatran due to reduced kidney function could be detected using the Hemoclot® diluted thrombin time (dTT) in this situation, in contrast to with non-dilutional assays. Before admission, cholestatic liver injury started shortly after initiation of dabigatran etexilate therapy. As no other cause was found, this liver injury was likely to be drug-induced. Bleeding cessated promptly after administration of idarucizumab in dabigatran intoxication. In conclusion, the anticoagulant effect of dabigatran can be measured by Hemoclot® dTT in sepsis and cholestatic liver injury was seen as a possible rare side-effect of dabigatran treatment.
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Comuth et al. (2017) conducted a case report in Dabigatran intoxication, severe gastro-intestinal bleeding, and cholestatic liver injury (n=1). Idarucizumab was evaluated on Bleeding cessation and coagulation assay response. Idarucizumab promptly ceased bleeding in dabigatran intoxication, and cholestatic liver injury was identified as a possible rare side-effect of dabigatran treatment.
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