Excess of Dabigatran Associated with Raised INR, PT, APTT in an Elderly Patient with Renal Impairment

Introduction: Dabigatran, a direct thrombin inhibitor, is an oral novel anticoagulant, which is used in stroke prophylaxis in non valvular atrial fibrillation. Despite it’s many benefits in use, lack of means to evaluate the anticoagulant effect and reversal agents, raise concerns of its use.
Case report: 74 year old patient admitted with a history of TIA and viral gastroenteritis with chronic bilateral lower limb ischemia, during two medical admissions with three weeks apart, on a complex medical background, including CKD- IIIa, known atrial fibrillation on dabigatran, noted to have raised INR, PT, APTT. No evidence of chronic liver disease and was not on any other anticoagulations.
Conclusion: Lack of ready available reliable means of monitoring dabigatran anticoagulant effect, safer dosing schemes in especially elderly patients with chronic renal impairment, warrants further research and dedicated studies.

Author(s): Anne Manjalee Liyanage, Vitthal Ramchandra Wadekar and Israr Un Nabi

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