Dabigatran Toxicity in Acute Kidney Injury: Hemodialysis and Idarucizumab Required

Abstract

Dabigatran is a direct thrombin inhibitor, the sole agent of its class. It is an effective anticoagulant1 with a specific antidote, idarucizumab.2 It is, however, renally cleared such that should patients prescribed dabigatran develop an acute kidney injury (AKI), a coagulopathic state can be anticipated. We describe a multimodal approach involving the use of hemodialysis and 3 doses of idarucizumab to manage coagulopathy and major hemorrhage in a patient prescribed dabiagatran with severe AKI. We also illustrate that dabiagatran can be implicated as a cause of acute interstitial nephritis.