Case PresentationĪ 58-year old Caucasian male with a history of recurrent paroxysmal AF came to the Emergency Department (ED) with the complaint of epistaxis. Here, we present a case of dabigatran etexilate-induced coagulopathy with extremely increased PT/INR in a patient with end-stage renal disease (ESRD). However, questions have been raised consistently regarding the safety of dabigatran etexilate. A recent study showed that approximately 725,000 patients in the United States have been on dabigatran etexilate.
Nearly 17 percent of patients with nonvalvular AF were started on dabigatran etexilate within just one year of approval. Since approval, the use of dabigatran etexilate has increased substantially.
Introductionĭabigatran etexilate is a novel oral anticoagulant approved by the Food and Drug Administration (FDA) for stroke prophylaxis in patients with nonvalvular atrial fibrillation (AF). Despite studies showing only mild increase in aPTT and PT/INR in patients receiving dabigatran, close monitoring may be reasonable in patients with renal insufficiency. Elderly patients over 75 and patients with chronic renal impairment should be carefully evaluated before starting dabigatran. Dabigatran is contraindicated in patients with severe kidney insufficiency as it is predominantly excreted via the kidney (~80%). His INR and aPTT trended downward, reaching normal levels 5 days after admission. Otherwise, all labs were unremarkable including the liver function test. His prothrombin time (PT) was 63 seconds with international normalized ratio (INR) of 8.8 and his activated partial thromboplastin time (aPTT) was 105.7 seconds. He had been started on dabigatran 150 mg twice a day about 4 months ago as an outpatient by his cardiologist. A 58-year-old Caucasian male with a history of recurrent paroxysmal atrial fibrillation status after pacemaker and end-stage renal disease on hemodialysis came to the Emergency Department with the complaint of severe epistaxis.
However, questions have been raised constantly regarding the safety of dabigatran etexilate. The use of dabigatran etexilate increased rapidly due to many benefits. Dabigatran is an oral direct thrombin inhibitor which has been approved for prophylaxis of stroke in patients with atrial fibrillation.
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