Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

Hemopericardium and Cardiac Tamponade in a Patient Treated with Dabigatran Etexilate

  • Received : 2015.02.23
  • Accepted : 2015.04.28
  • Published : 2016.01.30
⟨ Previous Next ⟩

Abstract

Dabigatran etexilate is one of the new oral anticoagulants approved to reduce the risk of stroke in patients with atrial fibrillation (AF). A variety of bleeding complications with dabigatran have been reported, but reports of hemopericardium are rare. We described a case of a 66 year-old female patient with non-valvular AF receiving dabigatran etexilate 150 mg twice daily for one year who suffered from hemopericardium. Her laboratory tests performed 1 year prior were normal and her admission tests revealed acute renal failure and elevated international normalized ratio (INR) level (4.79). Urgent pericardiocentesis was followed by improved renal functions and normalized INR. Dabigatran etexilate is a new oral anticoagulant that is increasingly used in daily practice. However, life-threatening complications warrant caution. Elevated INR may be related with overdose but the association of bleeding risk of dabigatran and INR requires further confirmation.

Keywords

References

  1. Wang TJ, Larson MG, Levy D, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation 2003;107:2920-5. https://doi.org/10.1161/01.CIR.0000072767.89944.6E
  2. Boehringer Ingelheim Pharmaceuticals Inc. Pradaxa (dabigatran etexilate) package insert. Ridgefield, CT: Author; 2011.
  3. Connolly SJ, Ezekowitz MD, Yusuf S, et al; RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139-51. https://doi.org/10.1056/NEJMoa0905561
  4. Lal Y, Van Heukelom J. Dabigatran: a cause of hematologic emergency. Am J Med Sci 2013;346:190-3. https://doi.org/10.1097/MAJ.0b013e31826c5a56
  5. Nyby S, Hennes O. Fatal bleeding diarrhoea during dabigatran etexilate therapy. Ugeskr Laeger 2014;176. pii: V09140482.
  6. Dy EA, Shiltz DL. Hemopericardium and cardiac tamponade associated with dabigatran use. Ann Pharmacother 2012;46:e18. https://doi.org/10.1345/aph.1R112
  7. Barton CA, McMillian WD, Raza SS, Keller RE. Hemopericardium in a patient treated with dabigatran etexilate. Pharmacotherapy 2012;32:e103-7. https://doi.org/10.1002/j.1875-9114.2012.01036.x
  8. Eikelboom JW, Wallentin L, Connolly SJ, et al. Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial. Circulation 2011;123:2363-72. https://doi.org/10.1161/CIRCULATIONAHA.110.004747
  9. Stangier J. Clinical pharmacokinetics and pharmacodynamics of the oral direct thrombin inhibitor dabigatran etexilate. Clin Pharmacokinet 2008;47:285-95. https://doi.org/10.2165/00003088-200847050-00001
  10. Kernan L, Ito S, Shirazi F, Boesen K. Fatal gastrointestinal hemorrhage after a single dose of dabigatran. Clin Toxicol (Phila) 2012;50:571-3. https://doi.org/10.3109/15563650.2012.705290
  11. Lindahl TL, Baghaei F, Blixter IF, et al; Expert Group on Coagulation of the External Quality Assurance in Laboratory Medicine in Sweden. Effects of the oral, direct thrombin inhibitor dabigatran on five common coagulation assays. Thromb Haemost 2011;105:371-8. https://doi.org/10.1160/TH10-06-0342
  12. Douxfils J, Mullier F, Robert S, Chatelain C, Chatelain B, Dogne JM. Impact of dabigatran on a large panel of routine or specific coagulation assays. Laboratory recommendations for monitoring of dabigatran etexilate. Thromb Haemost 2012;107:985-97. https://doi.org/10.1160/TH11-11-0804
  13. Kim J, Yadava M, An IC, et al. Coagulopathy and extremely elevated PT/INR after dabigatran etexilate use in a patient with end-stage renal disease. Case Rep Med 2013;2013:131395.
  14. van Ryn J, Stangier J, Haertter S, et al. Dabigatran etexilate--a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost 2010;103:1116-27. https://doi.org/10.1160/TH09-11-0758

Cited by

  1. Dabigatran etexilate overdose : Hemopericardium, cardiac tamponade and INR elevation: case report vol.1590, pp.1, 2016, https://doi.org/10.1007/s40278-016-15131-5
  2. First Reported Case of Hemopericardium Related to Dabigatran Use Reversed by New Antidote Idarucizumab vol.2017, pp.None, 2016, https://doi.org/10.1155/2017/6458636
  3. Dabigatran-Induced Spontaneous Hemopericardium and Cardiac Tamponade vol.44, pp.5, 2016, https://doi.org/10.14503/thij-16-6073
  4. Uma Combinação Fatal: Indometacina e Dabigatrana vol.114, pp.4, 2016, https://doi.org/10.36660/abc.20180159
  5. Vitamin K deficiency-induced spontaneous haemopericardium and cardiac tamponade in an infant with alpha-1 antitrypsin deficiency: a case report vol.5, pp.1, 2021, https://doi.org/10.1093/ehjcr/ytaa481