Key result
Dabigatran use linked to severe epistaxis causing hemorrhagic shock and RBC polyagglutination.
Why the study?
Issues related to dabigatran use, including laboratory monitoring, side effects like polyagglutination, and management in elderly patients with renal insufficiency, have not been completely clarified.
Case Report (n=1)
This case highlights the potential for severe bleeding and red blood cell polyagglutination complicating blood transfusions in elderly patients taking dabigatran.
May warrant vigilance for bleeding and polyagglutination with dabigatran in elderly; leaves open causal link and transfusion implications.
Dabigatran is an oral thrombin inhibitor which has been approved for prevention of stroke or embolism in atrial fibrillation patients as an alternative to vitamin K antagonists. Dabigatran has been introduced into clinical practice, although issues like laboratory monitoring, its use in elderly patients, drug and food interactions, and an antidote have not been completely clarified. Severe epistaxis leading to haemorrhagic shock occurred in an 89-year-old woman with atrial fibrillation and moderate renal insufficiency after 10 months of dabigatran 110 mg/b.i.d. Correction of the anaemia with blood transfusions became difficult because it was impossible to assess her blood group due to polyagglutination. The indirect Coombs test was very highly +++ positive for IgG. Investigations about previous hospital admissions disclosed that in 2011, her blood group was 0 positive. The course was complicated by an erysipela of the right upper extremity, most probably induced by an infection through a venous catheter. An increase in the knowledge about potential side effects of dabigatran-concerning infections and polyagglutination is urgently needed.
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Stöllberger et al. (2013) conducted a case report in Atrial fibrillation and moderate renal insufficiency (n=1). Dabigatran was evaluated on Severe epistaxis leading to haemorrhagic shock and red blood cell polyagglutination. An 89-year-old woman developed severe epistaxis leading to haemorrhagic shock and red blood cell polyagglutination after 10 months of dabigatran 110 mg twice daily.
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