Dabigatran-induced nephropathy and its successful treatment with Idarucizumab - case report and literature review

Thrombosis Research
Jenan AwesatLeonid Barski

Abstract

Anticoagulant induced renal injury has been previously described with Warfarin treatment. In the last decade direct oral anticoagulants (DOAC) were introduced. They include direct inhibitors of factor Xa (Rivaroxaban, Apixaban, Edoxaban) and a thrombin inhibitor (Dabigatran). There are isolated reports describing acute kidney injury (AKI) due to the use of DOACs. We report a clinical case of an 80-year-old patient recently started on Dabigatran for new onset atrial fibrillation. She presented with AKI and hematuria, urine specimen showed RBC casts, and a working diagnosis of anticoagulant nephropathy due to Dabigatran was made. During hospitalization she was treated with Idarucizumab with a full recovery of renal function. To the best of our knowledge, there are 4 published case reports describing kidney injury produced by Dabigatran. The use of DOACs is increasing rapidly, with increasing concern about its safety profile and, in particular, its potential harmful effect on renal function. As described in our case, treatment with Praxbind for Dabigatran induced kidney injury may be an acceptable management strategy that may obviate the need for urgent dialysis in selected cases by complete reversal of the AKI.

Citations

Jan 3, 2019·Current Opinion in Anaesthesiology·Benedikt TremlBettina Schenk
Apr 9, 2020·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Akshay AthavaleDarren M Roberts
Apr 2, 2020·Advances in Hematology·Mark Terence P MujerPrajwal Dhakal
Jun 23, 2020·Case Reports in Nephrology·Letizia ZeniGiovanni Cancarini
Jan 20, 2019·CEN Case Reports·Xin Li, Chi Yuen Cheung
Mar 1, 2019·Current Opinion in Anaesthesiology·Benedikt TremlBettina Schenk

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