Fatal Basilar Artery Occlusion Under Dabigatran Occurring 13 Days After Femoral Embolectomy

Abstract

A male with atrial fibrillation for 30 years underwent embolectomy in his right leg at age 78 years. Postoperatively, he received enoxaparin 60 mg/twice a day (bid), and on day 5, phenprocoumon was started. The patient's son, a general practitioner, changed phenprocoumon to dabigatran 110 mg/bid on day 8. Pain in his left calf induced readmission after 5 days. International normalized ratio was 2.5 and D-dimer was 20 μg/mL. Dabigatran was stopped and dalteparin 5000 International Units/bid and 40 μg alprostadil infusions were started. After 8 hours, he became comatose due to basilar artery occlusion and eventually died. This tragic case raises the issue of postoperative use of dabigatran, a recently introduced thrombin inhibitor.

Ischemic Stroke and Intestinal Bleeding Under Dabigatran in Metabolic Myopathy

“…The presented case is interesting for several reasons. First, it is one of the few cases so far reported who experienced an ischemic stroke 5 days after discontinuation of dabigatran . Including the present case, 11 individual cases have been reported so far, which experienced an ischemic stroke under dabigatran [Stöllbergr submitted].…”

“…Although ischemic stroke has been occasionally reported in patients under the new oral anticoagulant (NOAC) dabigatran , consecutive occurrence of a bleeding and a thromboembolic event has not been published. Here, we present a patient with the unusual consecutive occurrence of an intestinal bleeding shortly after discontinuation of dabigatran, followed by an ischemic stroke, which was not immediately recognized.…”