Document Detail

Neurosurgical complications of direct thrombin inhibitors--catastrophic hemorrhage after mild traumatic brain injury in a patient receiving dabigatran.
MedLine Citation:
PMID:  22394293     Owner:  NLM     Status:  MEDLINE    
Dabigatran etexilate is an oral anticoagulant that acts as a direct, competitive thrombin inhibitor. Large randomized clinical trials have shown higher doses of dabigatran (150 mg taken twice daily) to be superior to warfarin in terms of stroke and systemic embolism rates in patients with nonvalvular atrial fibrillation. As a result, in 2010 the US FDA approved the use of dabigatran for the prevention of stroke and systemic embolism in patients with atrial fibrillation. Dabigatran is especially attractive in the outpatient setting because patients do not require routine monitoring with prothrombin times or international normalized ratios. To date, no effective reversal agent for dabigatran in the event of catastrophic hemorrhage has been identified. The authors report a case of an elderly patient, being treated with dabigatran for atrial fibrillation, who presented with a rapidly expanding intracranial hemorrhage after a ground-level fall. This case highlights an impending neurosurgical quandary of complications secondary to this new anticoagulation agent and suggests potential options for management.
Sarah T Garber; Walavan Sivakumar; Richard H Schmidt
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2012-03-06
Journal Detail:
Title:  Journal of neurosurgery     Volume:  116     ISSN:  1933-0693     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-01     Completed Date:  2012-06-20     Revised Date:  2013-03-14    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1093-6     Citation Subset:  AIM; IM    
Department of Neurosurgery, University of Utah, Salt Lake City, Utah 84132, USA.
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MeSH Terms
Aged, 80 and over
Atrial Fibrillation / complications,  drug therapy
Benzimidazoles / adverse effects*,  therapeutic use
Brain Hemorrhage, Traumatic / chemically induced*,  etiology*
Brain Injuries / complications*
Factor VII / therapeutic use
Fatal Outcome
Glasgow Coma Scale
International Normalized Ratio
Partial Thromboplastin Time
Subarachnoid Hemorrhage / etiology
Thrombin / antagonists & inhibitors*
Tomography, X-Ray Computed
beta-Alanine / adverse effects,  analogs & derivatives*,  therapeutic use
Reg. No./Substance:
0/Benzimidazoles; 107-95-9/beta-Alanine; 9001-25-6/Factor VII; EC; I0VM4M70GC/dabigatran
Comment In:
J Neurosurg. 2013 Feb;118(2):483-4   [PMID:  23198798 ]
J Neurosurg. 2013 Feb;118(2):483
J Neurosurg. 2013 Feb;118(2):481-3   [PMID:  23198800 ]
J Neurosurg. 2013 Feb;118(2):485

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