Kim Benjamin, Garcia David A
Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA; and.
Division of Hematology, Department of Medicine, University of Washington, Seattle, WA.
Hematology Am Soc Hematol Educ Program. 2014 Dec 5;2014(1):514-7. doi: 10.1182/asheducation-2014.1.514. Epub 2014 Nov 18.
A 70-year-old male with a history of atrial fibrillation who is being anticoagulated with dabigatran etexilate presents to the emergency room with melena. He reports taking his most recent dose of dabigatran more than 2 hours ago. On examination, he is hypotensive and tachycardic, and he continues to have melanotic stools. Laboratory testing reveals a calculated creatinine clearance of 15 mL/min, a prothrombin time of 16.5 seconds (reference range: 11.8-15.2 seconds), an international normalized ratio of 1.2 (reference range: 0.9-1.2), and an activated partial thromboplastin time of 50 seconds (reference range: 22.2-33.0 seconds). You are asked by the emergency medicine physician whether hemodialysis should be considered to decrease the patient's plasma dabigatran level.
