Kashiura Masahiro, Fujita Hiroshi, Sugiyama Kazuhiro, Akashi Akiko, Hamabe Yuichi
Tertiary Emergency Medical Center Tokyo Metropolitan Bokutoh Hospital Tokyo Japan.
Department of Transfusion Medicine Tokyo Metropolitan Bokutoh Hospital Tokyo Japan.
Acute Med Surg. 2015 Jun 30;3(2):132-134. doi: 10.1002/ams2.123. eCollection 2016 Apr.
An 82-year-old man taking dabigatran was admitted with syncope. Computed tomography showed extravasation from the stomach. Laboratory data revealed renal insufficiency and prolonged activated partial thromboplastin time. The gastric endoscopy showed a gastric ulcer with an exposed vessel. However, an endoscopic hemostatic procedure failed to completely stop the bleeding. The patient experienced cardiac arrest from hypotensive shock. Spontaneous circulation returned after 5 min of resuscitation. After endoscopy, computed tomography showed a gastric perforation. For dabigatran removal, the patient underwent a 6-h hemodialysis session. Thrombin activity and thrombin-antithrombin complex increased during hemodialysis, while activated partial thromboplastin time decreased.
Good recovery was observed after dialysis and the following gastrectomy.
Hemodialysis should be considered for dabigatran removal in cases of life-threatening hemorrhage. The thrombin-antithrombin complex may be useful for monitoring the plasma dabigatran level.
一名82岁正在服用达比加群的男性因晕厥入院。计算机断层扫描显示胃有外渗。实验室数据显示肾功能不全及活化部分凝血活酶时间延长。胃镜检查显示胃溃疡且有血管外露。然而，内镜止血操作未能完全止血。患者因低血压性休克发生心脏骤停。复苏5分钟后恢复自主循环。内镜检查后，计算机断层扫描显示胃穿孔。为清除达比加群，患者接受了6小时的血液透析治疗。血液透析期间凝血酶活性及凝血酶 - 抗凝血酶复合物升高，而活化部分凝血活酶时间降低。
透析及随后的胃切除术后恢复良好。
在危及生命的出血情况下，应考虑进行血液透析以清除达比加群。凝血酶 - 抗凝血酶复合物可能有助于监测血浆达比加群水平。
