Jia Y, Wang SH, Cui NJ, Liu QX, Wang W, Li X, Gu YM, Zhu Y. Idarucizumab reverses dabigatran-induced anticoagulation in treatment of gastric bleeding: A case report. World J Clin Cases 2022; 10(8): 2537-2542 [PMID: 35434066 DOI: 10.12998/wjcc.v10.i8.2537]
Corresponding Author of This Article
Yan Zhu, MS, Attending Doctor, Department of Gastroenterology, Hospital of Integrated Traditional Chinese and Western Medicine, No. 3 East Yongding Road, Haidian District, Beijing 100039, China. zy815925@163.com
Research Domain of This Article
Geriatrics & Gerontology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yu Jia, Shao-Hua Wang, Na-Juan Cui, Quan-Xi Liu, Wei Wang, Xue Li, Yan Zhu, Department of Gastroenterology, Hospital of Integrated Traditional Chinese and Western Medicine, Beijing 100039, China
Ya-Mei Gu, Department of General Practice, Tiancun Community Health Service Centre, Beijing 100049, China
Author contributions: Jia Y and Zhu Y wrote and modified the manuscript; Wang SH performed the gastroscopy, confirmed the report, and provided the figures; Wang W and Li X collected the data; Cui N participated in the patient treatment; Zhu Y and Liu QX connected us to the pharmaceutical factory and purchased the idarucizumab; Gu YM and Wang SH reviewed the paper and provided suggestions for the revision; all authors have read and approved the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan Zhu, MS, Attending Doctor, Department of Gastroenterology, Hospital of Integrated Traditional Chinese and Western Medicine, No. 3 East Yongding Road, Haidian District, Beijing 100039, China. zy815925@163.com
Received: August 15, 2021 Peer-review started: August 15, 2021 First decision: October 20, 2021 Revised: October 30, 2021 Accepted: January 27, 2022 Article in press: January 27, 2022 Published online: March 16, 2022 Processing time: 207 Days and 22.4 Hours
Abstract
BACKGROUND
The drug instructions for dabigatran recommend adjusting the dosage to 110 mg twice daily for patients with bleeding risk, and performing at least one renal function test per year for patients with moderate renal impairment. However, owing to chronic insidiously worsening renal insufficiency, dabigatran can still accumulate abnormally, necessitating therapy with idarucizumab to reverse the anticoagulation due to severe erosive gastritis with widespread stomach mucosal bleeding.
CASE SUMMARY
A 76-year-old woman with a history of atrial fibrillation who took dabigatran 110 mg twice daily as directed to lessen the chance of stroke, was transported to the hospital with hematemesis and melena. Laboratory findings revealed severe life-threatening, blood-loss-induced anemia with a hemoglobin (Hb) level of 41.0 g/L and marked coagulation abnormalities with thrombin time (TT) > 180 s, most likely caused by dabigatran-induced metabolic disorder. Aggressive acid suppressive, hemostatic, and blood transfusion therapy resulted in the misconception that the bleeding was controlled, with subsequent rebleeding. Idarucizumab was administered in a timely manner to counteract dabigatran's anticoagulant impact, and 12 h later, TT was determined to be 17.4 s, which was within the normal range. Finally, the patient had no active bleeding signs and laboratory findings showed an Hb level of 104 g/L and TT of 17.7 s.
CONCLUSION
Renal function, coagulation function, and dabigatran concentration should be regularly monitored in older patients. Proton pump inhibitor and dabigatran coadministration is still controversial in preventing upper gastrointestinal tract bleeding.
Core Tip: The anticoagulatory effect of dabigatran resolves completely after five half-lives, which is approximately 2.5-3.5 d after the last dose for patients with normal renal function. Thrombin time (TT) is sensitive to the effects of dabigatran and can be prolonged even with trivial amounts of the drug. This patient exhibited persistent bleeding in the normal coagulation test (except for TT), possibly due to the anticoagulatory effects of the drug administered 4 days after the last dose for her renal insufficiency. Therefore, idarucizumab was administered for hemostasis, thus stopping the bleeding. This case highlights the importance of regular monitoring of renal function in older patients.
