The Need for a Coagulation Assay after Initiation of New Oral Anticoagulants in Patients with Renal Dysfunction: A Case Report

Journal of Clinical Neurology
Mi Ji LeeOh Young Bang

Abstract

Dabigatran etexilate, a new oral anticoagulant, was recently approved as an efficacious alternative to warfarin for the prevention of first and recurrent stroke in patients with nonvalvular atrial fibrillation. Limited data are available for dabigatran use in patients with a creatinine clearance rate (CrCL) of 15-30 mL/min. Furthermore, current guidelines do not recommend frequent blood monitoring after dabigatran use. We report herein a patient with severe renal dysfunction who exhibited profound coagulopathy after 2 days of dabigatran use. An 87-year-old woman was admitted for altered mental status and left-side weakness. She was diagnosed with right middle cerebral artery infarction. The baseline assessment revealed a serum creatinine concentration of 1.29 mg/dL and a CrCL of 27.2 mL/min. Dabigatran therapy was started 5 weeks after admission at a dosage of 110 mg twice daily. After 2 days of dabigatran use, the patient developed multiple bruises and evidence of upper-gastrointestinal bleeding. Laboratory tests demonstrated a severe coagulopathy, with a prothrombin time of 85.9 sec, an international normalized ratio of 11.36, an activated partial thromboplastin time of 119.2 sec, and a thrombin time of 230.8 sec. Serial asse...Continue Reading

References

Sep 1, 2009·The New England Journal of Medicine·Stuart J ConnollyUNKNOWN RE-LY Steering Committee and Investigators
Apr 6, 2011·Circulation·Graeme J Hankey, John W Eikelboom
Jul 27, 2011·Archives of Internal Medicine·Matthieu LegrandDidier Payen
Dec 14, 2011·Stroke; a Journal of Cerebral Circulation·Mark J AlbertsDavid A Garcia
Mar 22, 2012·The Canadian Journal of Cardiology·Allan C SkanesUNKNOWN Canadian Cardiovascular Society Atrial Fibrillation Guidelines Committee
Nov 17, 2012·Lancet Neurology·Mark J AlbertsGraeme J Hankey

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Citations

Nov 7, 2016·Clinical Chemistry and Laboratory Medicine : CCLM·Elisabeth Sellevoll LøkkebøUna Ørvim Sølvik
Jun 9, 2017·British Journal of Clinical Pharmacology·Jenneke LeentjensCornelis Kramers

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