Reversal of dabigatran-induced bleeding with a prothrombin complex concentrate and fresh frozen plasma

Abstract

Purpose: The case of a patient for whom reversal of dabigatran-induced bleeding was performed with a prothrombin complex concentrate (PCC) and fresh frozen plasma (FFP) is reported.

Summary: An 85-year-old man arrived at the emergency department with complaints of generalized weakness, fatigue, and one episode of dark stool. The patient's medical history included hypertension, heart failure, stage III chronic kidney disease, cerebrovascular accident, prostate cancer, gastritis, esophagitis, diverticulosis, and a bleeding gastrointestinal ulcer. Laboratory test results revealed acute liver failure, acute kidney injury, and anemia. He was diagnosed with hemorrhagic shock secondary to bleeding in his upper gastrointestinal tract. A reversal strategy was implemented using 16 units of FFP and 2000 units of a three-factor PCC. After administration of these agents, the patient's hemoglobin concentration stabilized, and there were no further signs of overt bleeding, suggesting potential hemostasis. Confirmation of this reversal was not possible due to the effect of concomitant liver failure on the International Normalized Ratio and the activated partial thromboplastin time (aPTT), common variables used to measure coagulation.

Conclusion: Treatment with a PCC and FFP was administered to an 85-year-old man diagnosed with hemorrhagic shock secondary to bleeding in his upper gastrointestinal tract in an effort to reverse the anticoagulant effects of dabigatran. Although the patient's hemoglobin levels stabilized and his aPTT values decreased after treatment, he died as a result of multiorgan failure.