Redistribution of dabigatran after idarucizumab administration in a 90-year-old woman with renal failure due to persistent large intestinal bleeding

摘要

A 90?year?old cachectic woman with hyper?tension, diabetes, permanent atrial fibrillation(CHA2DS2?VASc score, 6), and a history of isch?emic stroke (FIGURE 1A), treated with dabigatran110 mg twice a day, was admitted to the depart?ment of cardiology due to weakness and dehy?dration. Soon after admission, she was diagnosedwith major lower gastrointestinal bleeding asso?ciated with decreasing blood pressure. Laborato?ry tests performed 34 hours after dabigatran in?take revealed an elevated thrombin time of 234.6seconds, activated partial thromboplastin time(aPTT) of 180 seconds, and an international nor?malized ratio (INR) of 21. In addition, the pa?tient’s renal function deteriorated, with serumcreatinine level of 1.5 mg/dl, glomerular filtra?tion rate of 33 ml/min as estimated by the Mod?ification of Diet in Renal Disease Study equationand of 19 ml/min as calculated by the Cockroft–Gault equation, and hemoglobin concentrationof 12.5 g/dl. The plasma concentration of dabi?gatran was higher than 360 ng/ml (STA?ECA II,Diagnostica Stago, Paris, France) and could notbe quickly reduced due to poor diuresis.