Key result
Sequential argatroban and dabigatran with idarucizumab manages cancer-linked venous limb gangrene, enabling ~2-year survival.
Highlights the utility of direct oral anticoagulants and their reversal agents in managing severe cancer-associated hypercoagulability to facilitate definitive surgical and medical therapy.
Should not change practice; hypothesis-generating for DOAC reversal strategies in rare cancer-associated gangrene.
We report a case of lung adenocarcinoma-associated hypercoagulability leading to venous limb gangrene, managed successfully with argatroban and then dabigatran. Use of idarucizumab permitted diagnostic investigations, leading to targeted antineoplastic therapy with crizotinib, surgical resection with curative intent, and continued survival over 2 years after the index event.
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Waite et al. (2019) studied this question. Sequential argatroban and dabigatran, with idarucizumab reversal, successfully managed lung adenocarcinoma-associated venous limb gangrene, enabling surgery and survival over 2 years.
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