Case: An 82-year-old man taking dabigatran was admitted with syncope. Computed tomography showed extravasation from the stomach. Laboratory data revealed renal insufficiency and prolonged activated partial thromboplastin time. The gastric endoscopy showed a gastric ulcer with an exposed vessel. However, an endoscopic hemostatic procedure failed to completely stop the bleeding. The patient experienced cardiac arrest from hypotensive shock. Spontaneous circulation returned after 5 min of resuscitation. After endoscopy, computed tomography showed a gastric perforation. For dabigatran removal, the patient underwent a 6-h hemodialysis session. Thrombin activity and thrombin-antithrombin complex increased during hemodialysis, while activated partial thromboplastin time decreased.
Outcome: Good recovery was observed after dialysis and the following gastrectomy.
Conclusion: Hemodialysis should be considered for dabigatran removal in cases of life-threatening hemorrhage. The thrombin-antithrombin complex may be useful for monitoring the plasma dabigatran level.
Keywords: Anticoagulants; dabigatran etexilate; hemorrhage; peptic ulcer perforation; renal dialysis.