Dabigatran overload in acute kidney injury: haemodialysis or idarucizumab? A case report and proposal for a decisional algorithm

Abstract Dabigatran overload has been reported in acute kidney injury (AKI), leading to occasional major bleeding. Haemodialysis (HD) was the method used for reversing dabigatran anticoagulant effects before the approval of idarucizumab, which is now indicated for dabigatran reversal in major bleedi...

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Bibliographic Details
Published in:Clinical Kidney Journal 2021-02, Vol.14 (2), p.712-714
Main Authors: Galassi, Andrea, Podda, Gianmarco, Monciino, Paola, Stucchi, Andrea, Del Nero, Alberto, Cozzolino, Mario
Format: Article
Language:English
Subjects:
Algorithms
Anticoagulants (Medicine)
Dabigatran etexilate
Dutasteride
Exceptional Cases
Hydrochlorothiazide
Tranexamic acid
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Summary:Abstract Dabigatran overload has been reported in acute kidney injury (AKI), leading to occasional major bleeding. Haemodialysis (HD) was the method used for reversing dabigatran anticoagulant effects before the approval of idarucizumab, which is now indicated for dabigatran reversal in major bleeding or surgical emergencies. There have been reports of rebound of dabigatran levels following idarucizumab administration in AKI, requiring HD to achieve effective dabigatran clearance. However, a decisional algorithm to individualize treatments for dabigatran overload seems lacking. We present a case of dabigatran accumulation in obstructive AKI with minor bleeding that was successfully treated with HD and tranexamic acid without using idarucizumab, and propose a decision-making algorithm including different pathways in the management of suspected dabigatran overload in AKI.
ISSN:2048-8505
2048-8513
DOI:10.1093/ckj/sfaa011