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Kashiura M, Fujita H, Sugiyama K, et al. Hemodialysis for removal of dabigatran in a patient with gastric hemorrhage. Acute Med Surg. 2015;3(2):132-134doi: 10.1002/ams2.123.
Kashiura, M., Fujita, H., Sugiyama, K., Akashi, A., & Hamabe, Y. (2016). Hemodialysis for removal of dabigatran in a patient with gastric hemorrhage. Acute medicine & surgery, 3(2), 132-134. https://doi.org/10.1002/ams2.123
Kashiura, Masahiro, et al. "Hemodialysis for removal of dabigatran in a patient with gastric hemorrhage." Acute medicine & surgery vol. 3,2 (2016): 132-134. doi: https://doi.org/10.1002/ams2.123
Kashiura M, Fujita H, Sugiyama K, Akashi A, Hamabe Y. Hemodialysis for removal of dabigatran in a patient with gastric hemorrhage. Acute Med Surg. 2015 Jun 30;3(2):132-134. doi: 10.1002/ams2.123. eCollection 2016 Apr. PMID: 29123765; PMCID: PMC5667362.
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Acute Med Surg. 2015 Jun 30;3(2):132-134. doi: 10.1002/ams2.123. eCollection 2016 Apr.

Hemodialysis for removal of dabigatran in a patient with gastric hemorrhage.

Acute medicine & surgery

Masahiro Kashiura, Hiroshi Fujita, Kazuhiro Sugiyama, Akiko Akashi, Yuichi Hamabe

Affiliations

  1. Tertiary Emergency Medical Center Tokyo Metropolitan Bokutoh Hospital Tokyo Japan.
  2. Department of Transfusion Medicine Tokyo Metropolitan Bokutoh Hospital Tokyo Japan.

PMID: 29123765 PMCID: PMC5667362 DOI: 10.1002/ams2.123

Abstract

CASE: An 82-year-old man taking dabigatran was admitted with syncope. Computed tomography showed extravasation from the stomach. Laboratory data revealed renal insufficiency and prolonged activated partial thromboplastin time. The gastric endoscopy showed a gastric ulcer with an exposed vessel. However, an endoscopic hemostatic procedure failed to completely stop the bleeding. The patient experienced cardiac arrest from hypotensive shock. Spontaneous circulation returned after 5 min of resuscitation. After endoscopy, computed tomography showed a gastric perforation. For dabigatran removal, the patient underwent a 6-h hemodialysis session. Thrombin activity and thrombin-antithrombin complex increased during hemodialysis, while activated partial thromboplastin time decreased.

OUTCOME: Good recovery was observed after dialysis and the following gastrectomy.

CONCLUSION: Hemodialysis should be considered for dabigatran removal in cases of life-threatening hemorrhage. The thrombin-antithrombin complex may be useful for monitoring the plasma dabigatran level.

Keywords: Anticoagulants; dabigatran etexilate; hemorrhage; peptic ulcer perforation; renal dialysis

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