Abstract
The oral anticoagulant dabigatran etexilate can be a challenge when patients need acute surgery. Sepsis and acute renal failure exacerbate the anticoagulant effect. There is no specific reversal agent for dabigatran etexilate, but it can be removed by hemodialysis. We present a case where a patient treated with dabigatran etexilate was admitted to intensive care unit with severe sepsis and acute renal failure and in need of bilateral lower limp amputation due to ischemia. The patient had severe coagulopathy and was treated with continuous venovenous hemofiltration in attempt to remove dabigatran etexilate before surgery.
Highlights
Oral anticoagulant dabigatran etexilate is used for the prevention of stroke and systemic embolism in patients with atrial fibrillation, for treatment of deep venous thrombosis and pulmonary embolism
We present a case where a patient treated with dabigatran etexilate was admitted to intensive care unit with severe sepsis and acute renal failure and in need of bilateral lower limp amputation due to ischemia
We present a case where dabigatran etexilate caused severe coagulopathy in a patient with severe sepsis and acute renal failure in need of bilateral lower leg amputation
Summary
Oral anticoagulant dabigatran etexilate is used for the prevention of stroke and systemic embolism in patients with atrial fibrillation, for treatment of deep venous thrombosis and pulmonary embolism. A predictable pharmacodynamic effect makes fixed dosing without routine coagulation monitoring possible but may imply risks in critically ill patients. In critically ill patients with sepsis and renal failure the anticoagulant effect of dabigatran etexilate and the risk of bleeding can be significantly increased. Patients in need of acute surgery may be a challenge as no specific reversal agent exists. We present a case where dabigatran etexilate caused severe coagulopathy in a patient with severe sepsis and acute renal failure in need of bilateral lower leg amputation
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