Key result
Idarucizumab and hemodialysis fail to reverse dabigatran-induced coagulopathy lasting over 12 days.
Why the study?
The persistence of dabigatran effect causing life-threatening bleeding despite idarucizumab therapy and haemodialysis in sepsis with acute kidney injury is not well understood.
Case Report (n=1)
Idarucizumab and haemodialysis may be insufficient to reverse dabigatran-induced coagulopathy in patients with severe sepsis, acute kidney injury, and concurrent intravenous immunoglobulin therapy.
Prolonged dabigatran coagulopathy may occur despite idarucizumab and dialysis; this Level 5 case leaves open optimal reversal protocols in renal impairment.
A 58-year-old man presented with necrotising fasciitis and septic shock requiring urgent surgical debridement. Idarucizumab was used preoperatively to reverse the effects of dabigatran, which he was taking for chronic atrial fibrillation. He developed multiorgan failure including an oliguric acute kidney injury and was given continuous venovenous haemodiafiltration. Adjunctive intravenous immunoglobulin therapy was used in addition to his antibiotic therapy for necrotising fasciitis. Significant clinical and laboratory coagulopathy continued for over 12 days with evidence of a persistent dabigatran effect. Here, we discuss the potential impact of the immunoglobulin therapy, the patient's weight on the degree of redistribution of dabigatran seen and the oliguria in the context of an acute kidney injury on the apparent lack of the effectiveness of idarucizumab.
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Huggan et al. (2019) conducted a case report in Necrotising fasciitis, septic shock, persistent dabigatran effect (n=1). Idarucizumab and haemodialysis was evaluated on Clinical and laboratory coagulopathy. A 58-year-old man experienced significant clinical and laboratory coagulopathy for over 12 days due to persistent dabigatran effect despite idarucizumab therapy and haemodialysis.
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