open access

Vol 9, No 2 (2016)
Case report
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Perioperative management in patient receiving dabigatran etexilate for atrial fibrillation — case report

Piotr Kaźmierski, Rafał Ziółkowski, Michał Pająk
Journal of Transfusion Medicine 2016;9(2):54-60.

open access

Vol 9, No 2 (2016)
CASE REPORTS

Abstract

Introduction of new oral anticoagulants (Non-Vitamin K Antagonist Oral Anticoagulants- NOACs) helped to eliminate some vitamin K antagonist–related inconveniences. The main disadvantage of NOACs is the lack of specific antidote. Before any surgical emergency patients with vascular complications, who receive novel oral anticoagulants, require restoration of normal blood coagulation. This case report presents a 69-year old male patient, on regular dabigatran etexilate for atrial fibrillation (AF) who was admitted to the Department of Vascular, General and Oncologic Surgery (Copernicus Memorial Hospital, Lodz, Poland) for acute limb ischemia. He required immediate vascular surgery, but the high risk of intraoperative bleeding was recognized. Laboratory findings revealed a 7-fold prolongation of thrombin time (TT). The patient was qualified for dialysis and received activated prothrombin complex concentrate to restore blood coagulation. He was then subjected to successfull open embolectomy of the left iliac and femoral artery with no significant bleeding. He was discharged on the 14th postoperative day.

Patients with atrial fibrillation (AF) require permanent pharmacological prevention for stroke and systemic embolism. The medication used for the prevention of thromboembolic events may prove ineffective. Before an urgent surgical intervention patients, who receive novel oral anticoagulants, require restoration of normal blood coagulation. In such cases dialysis and administration of activated prothrombin complex concentrate may be a successfull option for reversing dabigatran-induced coagulopathy.

Abstract

Introduction of new oral anticoagulants (Non-Vitamin K Antagonist Oral Anticoagulants- NOACs) helped to eliminate some vitamin K antagonist–related inconveniences. The main disadvantage of NOACs is the lack of specific antidote. Before any surgical emergency patients with vascular complications, who receive novel oral anticoagulants, require restoration of normal blood coagulation. This case report presents a 69-year old male patient, on regular dabigatran etexilate for atrial fibrillation (AF) who was admitted to the Department of Vascular, General and Oncologic Surgery (Copernicus Memorial Hospital, Lodz, Poland) for acute limb ischemia. He required immediate vascular surgery, but the high risk of intraoperative bleeding was recognized. Laboratory findings revealed a 7-fold prolongation of thrombin time (TT). The patient was qualified for dialysis and received activated prothrombin complex concentrate to restore blood coagulation. He was then subjected to successfull open embolectomy of the left iliac and femoral artery with no significant bleeding. He was discharged on the 14th postoperative day.

Patients with atrial fibrillation (AF) require permanent pharmacological prevention for stroke and systemic embolism. The medication used for the prevention of thromboembolic events may prove ineffective. Before an urgent surgical intervention patients, who receive novel oral anticoagulants, require restoration of normal blood coagulation. In such cases dialysis and administration of activated prothrombin complex concentrate may be a successfull option for reversing dabigatran-induced coagulopathy.

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Keywords

dabigatran etexilate, acute limb ischemia, urgent vascular procedure, dialysis, activated prothrombin complex concentrate

About this article
Title

Perioperative management in patient receiving dabigatran etexilate for atrial fibrillation — case report

Journal

Journal of Transfusion Medicine

Issue

Vol 9, No 2 (2016)

Article type

Case report

Pages

54-60

Bibliographic record

Journal of Transfusion Medicine 2016;9(2):54-60.

Keywords

dabigatran etexilate
acute limb ischemia
urgent vascular procedure
dialysis
activated prothrombin complex concentrate

Authors

Piotr Kaźmierski
Rafał Ziółkowski
Michał Pająk

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