Dabigatran accumulation in acute kidney injury: is more better than less to prevent bleeding? A case report

Dabigatran accumulation in acute kidney injury: is more better than less to prevent bleeding? A case report

Dabigatran is an oral anticoagulant that is mainly renally excreted. Despite its efficacy in preventing

Abstract
Dabigatran is an oral anticoagulant that is mainly renally excreted. Despite its efficacy in preventing
thromboembolic events, concerns arise regarding bleeding complications in patients with acute kidney injury.
Idarucizumab is its specific antidote and reverses quickly and effectively dabigatran anticoagulation effects in
situations of severe bleeding or pending surgical procedures, but its benefit beyond these two indications remains
uncertain. We present a case of a woman with atrial fibrillation anticoagulated by dabigatran and admitted
with Streptococcus agalactiae meningitis, acute kidney injury and dabigatran accumulation. Idarucizumab was
not administered initially as she did not meet its current strict indications. However, subsequently, significant
bleeding necessitated its use. A rebound increase in dabigatran concentration was associated with an intracranial
hemorrhage, but the combination of additional doses of idarucizumab with hemodialysis lowered the dabigatran
concentration and prevented significant rebound increases. Further investigation into the optimal management of
dabigatran accumulation and acute kidney injury-associated bleeding is needed to enhance patient outcomes and

safety. Early initiation of hemodialysis together with idarucizumab administration may be crucial in preventing life-
threatening bleeding events in these patients.

Rafik Matbouli1

, Olivier Pantet2

, Julien Castioni3

, Nima Vakilzadeh4

, Lorenzo Alberio5

and Olivier Hugli1*

https://doi.org/10.1186/s12245-024-00677-3

2024

Peri Irawan

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