Dabigatran etexilate

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Intracranial haemorrhage: case report A 64-year-old man developed a fatal intracranial haemorrhage during anticoagulation with dabigatran etexilate [route and duration of treatment to reaction onset not stated]. The man, who had a history of non-valvular atrial fibrillation, hypertension, diabetes mellitus and immune thrombocytopenic purpura, was receiving dabigatran etexilate [Pradaxa] 150mg twice daily. His other medications included simvastatin, metoprolol, lisinopril and metformin. After falling from his work truck, he presented with mild confusion and a headache. Scans revealed an occipital skull fracture, right subdural haematoma with 7mm shift and bilateral subarachnoid bleeding. Laboratory investigations included the following: platelet count 49 × 109/L, activated partial thromboplastin time 44.3 sec, prothrombin time 14.9 sec and INR 1.4. Haemodialysis was initiated within 90 minutes of admission. After 3 hours of haemodialysis, a repeat CT scan revealed worsening subdural haematoma with a 15mm midline shift. The man underwent an emergency craniectomy for haematoma evacuation. He also received platelets and desmopressin. Additional scans revealed extensive right intracerebral haemorrhage, with bilateral hemispheric infarction and signs of herniation. He subsequently died. Author comment: "[T]he role of dialysis in dabigatranassociated life-threatening bleeding needs further evaluation." Verma A, et al. Promise and challenges of anticoagulation with dabigatran. Clinical Kidney Journal 5: 336-338, No. 4, Aug 2012. Available from: URL: http:// 803077570 dx.doi.org/10.1093/ckj/sfs068 - USA

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Reactions 29 Sep 2012 No. 1421