Reversal of dabigatran in a patient with ACS and recurrent pulmonary oedema

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Authors:  Colquhoun D.
Publication:  Heart Lung and Circulation
Year: 2016
Volume: 25
Supplement: 2
Start Page: S20

ABSTRACT:
History: A 68 year old male was admitted to respiratory with fever and worsening SOB. Diagnosis was chest infection in a heavy smoker with noted intermittent atrial fibrillation without angina but very elevated troponin. Medical History: Poorly controlled T2DM (HbA1c 10%), hypertension, diabetic retinopathy, mixed hyperlipidemia (TC 5, TG 3), F-P bypass with foot amputation, severe COAD, Iron deficiency (Ferritin 20). Treatment: Upon transfer to CCU, the patient was treated with antibiotics, their usual medications with Dabigatran 150mg bd commenced. Progress: Peak CK 500 IU/L, anterior Hypokinesis noted on Echocardiography, pulmonary oedema two nights in a row without angina needing BIPAP. A clinical decision on day 3 was made to proceed to urgent angiogram. Anticoagulation was reversed with bolus Idarucizumab over 15 minutes, 7 hours after last dose of dabigatran. Angiogram was performed (entry via stented right-femoral artery) with no post-procedural haematoma. Post-angiogram, patient received 1000mg infusion of Ferritin. Patient proceeded with CABG 36 hours post-angiogram for severe acute vessel disease. Dabigatran was recommenced on Day 5 of admission post-bypass. Points of Interest: 1) Simplicity of reversal of Dabigatran in a critical clinical setting 2) Less than optimal risk factor management when patient care is dominated by urgent surgery and procedure. 3) Smoking cessation is doctors’ business.

  • Listing ID: 4800
  • Author/s: Colquhoun D.
  • Publication: Heart Lung and Circulation
  • Year: 2016
  • Volume: 25
  • Issue: 2
  • Start Page: S20
  • Article Keywords: aged, angina pectoris, anticoagulation, atrial fibrillation, case report, chest infection, diabetic retinopathy, diagnosis, echocardiography, familial hyperlipemia, femoral artery, fever, foot amputation, hematoma, human, hypertension retinopathy, hypokinesia, infusion, iron deficiency, male, medical history, night, patient care, risk factor, smoking cessation, surgery