Dabigatran anticoagulation and Stanford type A aortic dissection: Lethal coincidence: Case report with literature review

  • P. S
  • M. B
  • B. B
 et al. 
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Abstract

Background Novel oral anticoagulants are now encountered in patients needing emergency surgery. Knowledge and treatment options are limited. Methods and result We present the case of a 76-year-old patient who suffered from an acute Stanford type A aortic dissection, needing emergency surgical aortic repair. He was anticoagulated with dabigatran due to past atrial fibrillation. Despite haemodiafiltration, surgical revision and massive transfusion of packed red blood cells, fresh frozen plasma, platelets, coagulation factors, and recombinant factor VIIa, the patient died from intractable bleeding with sustained therapeutic levels of dabigatran. Conclusion After reviewing the literature, we summarize the limited treatment options and show possible approaches for patients treated with dabigatran needing emergency surgery. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Author-supplied keywords

  • Medtronic Freestyle prosthesis
  • aged
  • antibiotic prophylaxis
  • anticoagulant therapy
  • aortic aneurysm
  • aortic clamping
  • aortic dissection
  • aortic prosthesis
  • aortic reconstruction
  • aortic regurgitation
  • aortic root
  • aortic valve
  • aortic wall
  • arterial line
  • artery catheterization
  • ascending aorta
  • atrial fibrillation
  • bicarbonate
  • bleeding
  • blood clotting disorder
  • blood clotting factor
  • blood clotting factor 13
  • blood clotting factor 5
  • blood flow
  • blood volume
  • brain perfusion
  • cardioplegia
  • cardiopulmonary bypass
  • cardioversion
  • case report
  • cefuroxime
  • central venous catheter
  • crystalloid
  • dabigatran
  • echocardiography
  • emergency surgery
  • endotracheal intubation
  • erythrocyte concentrate
  • erythrocyte transfusion
  • female
  • fibrinolysis
  • fresh frozen plasma
  • heart atrium appendage
  • heart left ventricle hypertrophy
  • heart massage
  • heart right ventricle function
  • heart tamponade
  • hematoma
  • hemodiafiltration
  • hemodynamics
  • hemostasis
  • heparin
  • human
  • hypertension
  • inferior cava vein
  • intensive care unit
  • international normalized ratio
  • jugular vein
  • lactic acid
  • long term care
  • mannitol
  • metabolic acidosis
  • nebivolol
  • noradrenalin
  • operative blood loss
  • pericardial effusion
  • perindopril
  • plasma transfusion
  • priority journal
  • protamine
  • prothrombin complex
  • radial artery
  • recombinant blood clotting factor 7a
  • review
  • sternotomy
  • subclavian artery
  • thorax drainage
  • thorax pain
  • thrombin time
  • thrombocyte count
  • thrombocyte transfusion
  • thromboelastography
  • tranexamic acid
  • transesophageal echocardiography
  • vasopressin
  • von Willebrand factor

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Authors

  • Stein P.

  • Bosshart M.

  • Brand B.

  • Schlicker A.

  • Spahn D.R.

  • Bettex D.

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