![]() ![]() Laboratory analyses (table 2) showed acute kidney failure and high inflammatory parameters.Ī diagnostic puncture of the shoulder evacuated blood without crystals. She showed a mildly disoriented mental state, diffuse abdominal pain and a swollen and painful right shoulder. On arrival, her vital parameters were: temperature 36.7 ☌, atrial fibrillation (89/min), blood pressure 106/59 mmHg, respiratory rate 18/min and an O 2 saturation of 95% on room air. A week previously, triamcinolone was injected in her right shoulder because of subacromial syndrome. Her medical history included chronic kidney disease (estimated glomerular filtration rate using CKD-EPI: 44 ml/min/1.73 m2), heart failure (moderate left ventricular function), and atrial fibrillation (CHAD-VASC score of 7) which had been treated for four years with amiodarone and dabigatran 110 mg twice daily, a dosage adjusted to the pre-existing decreased renal function (table 1). In case of persisting bleeding and high dabigatran levels, renal replacement therapy is an acceptable therapeutic option.Īn 85-year-old female presented to the emergency department with pain in her right shoulder and confusion. The rebound is best monitored by the diluted thrombin time and may be treated with repeated doses of idarucizumab. ![]() The risk of anticoagulation rebound is higher with higher initial dabigatran levels and is associated with the severity of renal insufficiency. Treatment of dabigatran-related bleeding with idarucizumab may be complicated by a rebound effect presenting as the reappearance of dabigatran after an initial response. ![]() ![]() Important risk factors for high dabigatran concentrations and prolonged coagulation are renal insufficiency, drug-drug interactions and older age. Despite multiple attempts to correct the bleeding, it continued and the coagulation times remained prolonged. In this case report, we describe an 85-year-old female patient who presented with a rare but important problem of anticoagulant rebound complicating dabigatran use. ![]()
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