Anest. intenziv. Med. 2018;29(4):201-206

Spontaneous rebound of the anticoagulant effect of accumulated dabigatran after the antagonist activity cessation: Case report of life-threatening haemorrhageCase Report

J. Pažout^1,*, M. Mikešová², F. Duška¹

¹ Klinika anesteziologie a resuscitace, 3. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady

² Laboratoř hematologie, Ústav laboratorní diagnostiky, Fakultní nemocnice Královské Vinohrady

NOAC (Non-Vitamin K Oral Anticoagulants) are currently increasingly used for treatment of thromboembolism. The main reason for their popularity is the possibility of oral application without the need to monitor their effect. In our report we describe the case of an 81-year-old man with paroxysmal atrial fibrillation treated with dabigatran, which accumulated in the patient, resulting in a life-threatening gastrointestinal bleeding. The patient was first treated with a prothrombin complex concentrate and then the selective dabigatran antagonist idarucizumab. An important finding from the case report was the existence of rebound phenomenon of returning anticoagulant activity of NOAC after application of idarucizumab due to accumulation of the dabigatran.

Keywords: dabigatran; hemorrhage; idarucizumab; prothrombin complex concentrate; renal insufficiency

Received: March 23, 2018; Accepted: June 30, 2018; Published: August 1, 2018  Show citation