A Massive Intake of Dabigatran: Case-Report and Short Review

Abstract

Objective: The toxicity profile of new oral anticoagulants is well established and with their increasing use the adverse events are frequently encountered in clinical practice. Here, we describe the haemostatic abnormalities after a massive ingestion of dabigatran. Case summary: A 69-year-old woman was admitted for suicidal attempt after ingestion of 9 grams of dabigatran (60 x 150mg pills), associated with 400 mg of nebivolol, 600 mg of diazepam and 1.5 grams of amitriptyline. The patient did not suffer from any bleeding events. Only few voluntary massive intakes are until now reported. Discussion: There are only few cases reporting such a massive voluntary intake of dabigatran leading to biological disorders contrasting with no clinically significant intake. This surprising absence of bleeding events in our case could be at least partly explained by the poor gastrointestinal intake of the drug, a functional gastroparesis, and a theoretically self-limiting biological effect. Conclusion: As no antidote is currently available in routine use for dabigatran, a systematic collection of cases of dabigatran toxicity provide an insight into the clinical manifestations and potential therapeutic implications.