초록 열기/닫기 버튼
Background Dabigatran etexilate, a new oral anticoagulant, was recently approved as an efcacious alternative to warfarin for the prevention of frst and recurrent stroke in patients with nonvalvular atrial fbrillation. Limited data are available for dabigatran use in patients with a creatinine clearance rate (CrCL) of 15–30 mL/min. Furthermore, current guidelines do not recommend frequent blood monitoring afer dabigatran use. We report herein a patient with severe renal dysfunction who exhibited profound coagulopathy afer 2 days of dabigatran use. Case Report An 87-year-old woman was admitted for altered mental status and lef-side weakness. She was diagnosed with right middle cerebral artery infarction. Te baseline assessment revealed a serum creatinine concentration of 1.29 mg/dL and a CrCL of 27.2 mL/ min. Dabigatran therapy was started 5 weeks afer admission at a dosage of 110 mg twice daily. Afer 2 days of dabigatran use, the patient developed multiple bruises and evidence of upper-gastrointestinal bleeding. Laboratory tests demonstrated a severe coagulopathy, with a prothrombin time of 85.9 sec, an international normalized ratio of 11.36, an activated partial thromboplastin time of 119.2 sec, and a thrombin time of 230.8 sec. Serial assessment of the patient’s renal function revealed substantial fuctuation of the CrCL (range, 17.9–26.5 mL/ min). Conclusions Te present case emphasizes the need for frequent checking of renal function and assessment using coagulation assays afer commencing dabigatran therapy in patients with moderate-to-severe renal impairment.
