Document Detail


Positive outcome after intentional overdose of dabigatran.
MedLine Citation:
PMID:  23212788     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Dabigatran (Pradaxa™), an orally active direct thrombin inhibitor, was approved by the United States Food and Drug Administration for the prevention of stroke in patients with atrial fibrillation in October 2010. Life-threatening consequences from dabigatran therapy include hemorrhage and bleeding complications, but they typically occur after renal impairment. We describe the first case report of intentional, acute overdose with dabigatran.
CASE REPORT: A 57-year-old woman with a medical history of depression and atrial fibrillation presented to the emergency department after ingesting 11.25 g of dabigatran in a suicide attempt. Despite an ecchymosis indicative of prior trauma, there was no evidence of acute bleeding. After receiving gastric lavage and activated charcoal therapy in the emergency department, she was admitted to the ICU. On presentation, dabigatran blood levels measured 970 ng/mL and thrombin clot times measured above the testable limits (>120 s) until 52 h post-arrival. The remainder of her clinical course was uncomplicated, and the patient was transferred to an inpatient psychiatric unit for depression follow-up.
DISCUSSION: This case shows the clinical course of a patient with an acute, massive dabigatran overdose with no significant clinical consequences. Currently, there is no ideal method to monitor anticoagulation levels; there is no pharmacologic reversal method, and hemodialysis is an undesirable treatment option.
Authors:
Jason S Woo; Neel Kapadia; Sarah E Phanco; Catherine A Lynch
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of medical toxicology : official journal of the American College of Medical Toxicology     Volume:  9     ISSN:  1937-6995     ISO Abbreviation:  J Med Toxicol     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-05-20     Completed Date:  2013-12-17     Revised Date:  2014-06-03    
Medline Journal Info:
Nlm Unique ID:  101284598     Medline TA:  J Med Toxicol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  192-5     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Antithrombins / blood,  pharmacokinetics,  poisoning*
Benzimidazoles / blood,  pharmacokinetics,  poisoning*
Charcoal / therapeutic use
Chelating Agents / therapeutic use
Drug Overdose / blood,  therapy*
Emergency Service, Hospital
Female
Gastric Lavage
Humans
Middle Aged
Suicide, Attempted
Treatment Outcome
beta-Alanine / analogs & derivatives*,  blood,  pharmacokinetics,  poisoning
Chemical
Reg. No./Substance:
0/Antithrombins; 0/Benzimidazoles; 0/Chelating Agents; 11P2JDE17B/beta-Alanine; 16291-96-6/Charcoal; I0VM4M70GC/dabigatran
Comments/Corrections

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