Hemodialysis for removal of dabigatran in a patient with gastric hemorrhage

Abstract

Case: An 82-year-old man taking dabigatran was admitted with syncope. Computed tomography showed extravasation from the stomach. Laboratory data revealed renal insufficiency and prolonged activated partial thromboplastin time. The gastric endoscopy showed a gastric ulcer with an exposed vessel. However, an endoscopic hemostatic procedure failed to completely stop the bleeding. The patient experienced cardiac arrest from hypotensive shock. Spontaneous circulation returned after 5min of resuscitation. After endoscopy, computed tomography showed a gastric perforation. For dabigatran removal, the patient underwent a 6-h hemodialysis session. Thrombin activity and thrombin-antithrombin complex increased during hemodialysis, while activated partial thromboplastin time decreased. Outcome: Good recovery was observed after dialysis and the following gastrectomy. Conclusion: Hemodialysis should be considered for dabigatran removal in cases of life-threatening hemorrhage. The thrombin-antithrombin complex may be useful for monitoring the plasma dabigatran level.