Dabigatran-induced Gastrointestinal Bleed Treated by 4-factor Prothrombin Complex Concentrate in a Tertiary Care Hospital in Sikkim

An immediate need exists for a safe, quick, and effective reversal agent in patients who present with anticoagulant-induced major bleed. Dabigatran, a newer oral anticoagulant and a direct thrombin inhibitor (DTI), can also induce bleeding risk. Idarucizumab is a specific dabigatran reversal drug that the United States Food and Drug Administration (US FDA) has approved in the event of a significant bleeding caused by this drug. In this particular drug-related bleeding, it can be challenging to precisely dose alternative reversal agents like prothrombin complex concentrates (PCCs) and activated PCCs (aPCCs) depending on coagulation characteristics. Additionally, they may result in thromboembolic problems. Despite these drawbacks, the inability to get idarucizumab may necessitate the use of these medications in cases of life-threatening bleeding. We describe the case of a 65-year-old male who reported to the hospital with coagulopathy, anemia, and fresh bleeding per rectum (Hb: 5.8 gm/dL, PT 20.02 seconds, INR: 1.55). He was on dabigatran for the past 1 month. Even after stopping dabigatran, injection of vitamin K, 4 units of blood transfusion, and 8 units of fresh frozen plasma (FFP), he was still bleeding, with fall in hemoglobin level. Following the administration of PCC, he significantly improved, and no additional transfusion products were needed. He could be sent home after 4 days. After 1 month, he returned for follow-up with no further complications.

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A 65-year-old man on dabigatran developed gastrointestinal bleeding that persisted despite stopping the drug, vitamin K, blood transfusion, and fresh frozen plasma; four-factor prothrombin complex concentrate led to significant improvement with no further transfusions needed and no complications at one-month follow-up.

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