• Der Anaesthesist · Aug 2020

    Case Reports

    [TEG-guided treatment of a dabigatran overdose in a patient with acute kidney failure].

    • K-W Lorenz and R Schäfer.
    • Klinik für Anästhesie, operative Intensiv- und Palliativmedizin, Klinikum Würzburg Mitte - Standort Juliusspital, Juliuspromenade 19, 97070, Würzburg, Deutschland. k.lorenz@kwm-klinikum.de.
    • Anaesthesist. 2020 Aug 1; 69 (8): 573-578.

    AbstractThis article presents the case of a multimorbid male patient with an accidental dabigatran overdose caused by kidney failure in the context of an acute intestinal disorder. After effective initial antagonizing of the dabigatran effect using idarucizumab a dabigatran rebound was detected caused by a single hemodialysis leading to a severe intrapulmonary hemorrhage. As dabigatran plasma level testing was not available and conventional coagulation analysis was out of interpretable range due to the impact of dabigatran, continuous thrombelastography (TEG) was used to detect the effect of dabigatran and monitor the treatment results. The most significant parameter used in the kaolin activated clotting time was the R‑time parameter, which was massively prolonged by the interrupted coagulation cascade.

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