Key result
Hemodialysis and 3 doses of idarucizumab were used to manage coagulopathy and major hemorrhage in a patient with dabigatran toxicity and severe acute kidney injury.
Why the study?
Because dabigatran is renally cleared, patients prescribed dabigatran who develop acute kidney injury are anticipated to develop a coagulopathic state.
Case Report (n=1)
In cases of severe dabigatran toxicity complicated by acute kidney injury, a multimodal approach using hemodialysis and multiple doses of idarucizumab may be required to manage major hemorrhage.
May warrant multimodal reversal with hemodialysis and repeated idarucizumab in dabigatran toxicity with AKI; leaves open optimal protocols.
Dabigatran is a direct thrombin inhibitor, the sole agent of its class. It is an effective anticoagulant1 with a specific antidote, idarucizumab.2 It is, however, renally cleared such that should patients prescribed dabigatran develop an acute kidney injury (AKI), a coagulopathic state can be anticipated. We describe a multimodal approach involving the use of hemodialysis and 3 doses of idarucizumab to manage coagulopathy and major hemorrhage in a patient prescribed dabiagatran with severe AKI. We also illustrate that dabiagatran can be implicated as a cause of acute interstitial nephritis.
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McBride et al. (2018) conducted a case report in Dabigatran toxicity with severe acute kidney injury (n=1). Hemodialysis and idarucizumab was evaluated. Hemodialysis and 3 doses of idarucizumab were used to manage coagulopathy and major hemorrhage in a patient with dabigatran toxicity and severe acute kidney injury.
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