Arun Kumar Dahiya

Abstract

Surgeons are required to keep themselves updated on ever-increasing list of drugs that may influence the outcomes of surgeries, especially in an emergency scenario. Here, we report a case of acute abdomen, wherein the patient was on dabigatran, a ‘Non-vit. K/Direct Oral Anti-Coagulant’ (NOAC/DOAC). NOACs are relatively recent additions to anticoagulation care. In our patient, dabigatran was prescribed by a cardiologist to prevent the occurrence of stroke in the patient who was suffering from atrial fibrillation. In case of uncontrolled bleeding, or when an emergency surgery is needed, the effect of dabigatran can be reversed with the use of a specific monoclonal antibody – idarucizumab. Knowledge about the drug & its reversal agent, and a multi-disciplinary approach, could make it possible for us to operate on the patient, and avoid excessive bleeding during the surgery. Keywords: Anticoagulant dabigatran etexilate emergency surgery idarucizumab.

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Abstract

There remains a risk of ischemic strokes in patients of atrial fibrillation receiving oral anticoagulants. Systemic thrombolysis in such cases poses a challenge, but may be possible after reversal of anticoagulant effect. We report a case of 61-year old male patient with non-valvular atrial fibrillation who was taking dabigatran. The patient developed ischemic stroke few hours after taking the last dose of the anticoagulant. Reversal of dabigatran was achieved using idarucizumab, and the patient was successfully thrombolysed. This case-report adds to the growing evidence that such a strategy is now possible with the advent of reversal agents against non-vitamin K antagonist oral anticoagulants. Keywords: Stroke, Dabigatran, Idarucizumab, Reversal.

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