STEIN P, BOSSHART M, BRAND B, SCHLICKER A, SPAHN DR, BETTEX D. Dabigatran anticoagulation and Stanford type A aortic dissection: lethal coincidence: Case report with literature review.
Acta Anaesthesiol Scand 2014;
58:630-7. [PMID:
24601892 DOI:
10.1111/aas.12303]
[Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND
Novel oral anticoagulants are now encountered in patients needing emergency surgery. Knowledge and treatment options are limited.
METHODS AND RESULT
We present the case of a 76-year-old patient who suffered from an acute Stanford type A aortic dissection, needing emergency surgical aortic repair. He was anticoagulated with dabigatran due to past atrial fibrillation. Despite haemodiafiltration, surgical revision and massive transfusion of packed red blood cells, fresh frozen plasma, platelets, coagulation factors, and recombinant factor VIIa, the patient died from intractable bleeding with sustained therapeutic levels of dabigatran.
CONCLUSION
After reviewing the literature, we summarize the limited treatment options and show possible approaches for patients treated with dabigatran needing emergency surgery.
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