Coagulopathy and Extremely Elevated PT/INR after Dabigatran Etexilate Use in a Patient with End-Stage Renal Disease
Introduction. Dabigatran is an oral direct thrombin inhibitor which has been approved for prophylaxis of stroke in patients with atrial fibrillation. The use of dabigatran etexilate increased rapidly due to many benefits. However, questions have been raised constantly regarding the safety of dabigat...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2013-01-01
|
| Series: | Case Reports in Medicine |
| Online Access: | http://dx.doi.org/10.1155/2013/131395 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850162217242066944 |
|---|---|
| author | Joonseok Kim Mrinal Yadava In Chul An Abrar Sayeed Heather S. Laird-Fick Venu Gourineni George S. Abela |
| author_facet | Joonseok Kim Mrinal Yadava In Chul An Abrar Sayeed Heather S. Laird-Fick Venu Gourineni George S. Abela |
| author_sort | Joonseok Kim |
| collection | DOAJ |
| description | Introduction. Dabigatran is an oral direct thrombin inhibitor which has been approved for prophylaxis of stroke in patients with atrial fibrillation. The use of dabigatran etexilate increased rapidly due to many benefits. However, questions have been raised constantly regarding the safety of dabigatran etexilate. Case. 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. He had been started on dabigatran 150 mg twice a day about 4 months ago as an outpatient by his cardiologist. 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. Otherwise, all labs were unremarkable including the liver function test. Dabigatran was stopped immediately. His INR and aPTT trended downward, reaching normal levels 5 days after admission. Conclusion. Dabigatran is contraindicated in patients with severe kidney insufficiency as it is predominantly excreted via the kidney (~80%). Elderly patients over 75 and patients with chronic renal impairment should be carefully evaluated before starting dabigatran. 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. |
| format | Article |
| id | doaj-art-fa6ff45e4af442019ff2c55e91cc5ebf |
| institution | OA Journals |
| issn | 1687-9627 1687-9635 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Medicine |
| spelling | doaj-art-fa6ff45e4af442019ff2c55e91cc5ebf2025-08-20T02:22:37ZengWileyCase Reports in Medicine1687-96271687-96352013-01-01201310.1155/2013/131395131395Coagulopathy and Extremely Elevated PT/INR after Dabigatran Etexilate Use in a Patient with End-Stage Renal DiseaseJoonseok Kim0Mrinal Yadava1In Chul An2Abrar Sayeed3Heather S. Laird-Fick4Venu Gourineni5George S. Abela6Department of Medicine, Michigan State University, East Lansing, MI 48824, USADepartment of Medicine, Michigan State University, East Lansing, MI 48824, USADepartment of Medicine, Michigan State University, East Lansing, MI 48824, USADepartment of Medicine, Michigan State University, East Lansing, MI 48824, USADepartment of Medicine, Michigan State University, East Lansing, MI 48824, USADepartment of Medicine, Michigan State University, East Lansing, MI 48824, USADepartment of Medicine, Michigan State University, East Lansing, MI 48824, USAIntroduction. Dabigatran is an oral direct thrombin inhibitor which has been approved for prophylaxis of stroke in patients with atrial fibrillation. The use of dabigatran etexilate increased rapidly due to many benefits. However, questions have been raised constantly regarding the safety of dabigatran etexilate. Case. 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. He had been started on dabigatran 150 mg twice a day about 4 months ago as an outpatient by his cardiologist. 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. Otherwise, all labs were unremarkable including the liver function test. Dabigatran was stopped immediately. His INR and aPTT trended downward, reaching normal levels 5 days after admission. Conclusion. Dabigatran is contraindicated in patients with severe kidney insufficiency as it is predominantly excreted via the kidney (~80%). Elderly patients over 75 and patients with chronic renal impairment should be carefully evaluated before starting dabigatran. 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.http://dx.doi.org/10.1155/2013/131395 |
| spellingShingle | Joonseok Kim Mrinal Yadava In Chul An Abrar Sayeed Heather S. Laird-Fick Venu Gourineni George S. Abela Coagulopathy and Extremely Elevated PT/INR after Dabigatran Etexilate Use in a Patient with End-Stage Renal Disease Case Reports in Medicine |
| title | Coagulopathy and Extremely Elevated PT/INR after Dabigatran Etexilate Use in a Patient with End-Stage Renal Disease |
| title_full | Coagulopathy and Extremely Elevated PT/INR after Dabigatran Etexilate Use in a Patient with End-Stage Renal Disease |
| title_fullStr | Coagulopathy and Extremely Elevated PT/INR after Dabigatran Etexilate Use in a Patient with End-Stage Renal Disease |
| title_full_unstemmed | Coagulopathy and Extremely Elevated PT/INR after Dabigatran Etexilate Use in a Patient with End-Stage Renal Disease |
| title_short | Coagulopathy and Extremely Elevated PT/INR after Dabigatran Etexilate Use in a Patient with End-Stage Renal Disease |
| title_sort | coagulopathy and extremely elevated pt inr after dabigatran etexilate use in a patient with end stage renal disease |
| url | http://dx.doi.org/10.1155/2013/131395 |
| work_keys_str_mv | AT joonseokkim coagulopathyandextremelyelevatedptinrafterdabigatranetexilateuseinapatientwithendstagerenaldisease AT mrinalyadava coagulopathyandextremelyelevatedptinrafterdabigatranetexilateuseinapatientwithendstagerenaldisease AT inchulan coagulopathyandextremelyelevatedptinrafterdabigatranetexilateuseinapatientwithendstagerenaldisease AT abrarsayeed coagulopathyandextremelyelevatedptinrafterdabigatranetexilateuseinapatientwithendstagerenaldisease AT heatherslairdfick coagulopathyandextremelyelevatedptinrafterdabigatranetexilateuseinapatientwithendstagerenaldisease AT venugourineni coagulopathyandextremelyelevatedptinrafterdabigatranetexilateuseinapatientwithendstagerenaldisease AT georgesabela coagulopathyandextremelyelevatedptinrafterdabigatranetexilateuseinapatientwithendstagerenaldisease |