Induction of Remission in Ulcerative Colitis with Dabigatran: A Case Report

Abstract

Purpose: To report the first case of inducing remission in ulcerative colitis (UC) with dabigatran, a direct thrombin inhibitor. A 54-year-old man with a long history of steroid-dependent UC presents with dyspnea. A chest CT reveals an acute pulmonary embolism. Treatment with warfarin is begun, but later stopped due to the inconvenience of monitoring; dabigatran, an oral direct thrombin inhibitor, is started. Shortly after beginning therapy with dabigatran, the symptoms of UC improve with normalization of bowel habits. A subsequent colonoscopy reveals healing of colitis with marked improvement in endoscopic inflammation. The patient is able to discontinue steroids for the first time in 21 years. He remains on dabigatran and continues in remission for one year off steroids on maintenance mesalamine. There are reports of induction of remission of UC with unfractionated and low molecular weight heparin, findings thought due to the anti-inflammatory effects of heparin, rather than to its anticoagulant effects. This represents the first known report describing induction of remission in UC with dabigatran, a direct thrombin inhibitor. The mechanism of action for dabigatran in UC is uncertain; however, in a murine model of interstitial lung disease, dabigatran has been associated with reduced levels of transforming growth factor-β1 and platelet derived growth factor, both proteins implicated in the pathogenesis of inflammatory bowel disease. How the anticoagulant effects of dabigatran relate to healing of UC in this patient remains unclear. Direct thrombin inhibitors, such as dabigatran, may represent a novel therapeutic class in the treatment of ulcerative colitis.Figure: [1253] Colitis, prior to dabigatran.Figure: [1253] Healed colitis, post dabigatran use.