Dabigatran etexilate, a direct thrombin inhibitor, was recently introduced in clinical use
to prevent thromboembolic events in patients with risk factors (such as non-valvular atrial fibrillation
or deep vein thrombosis). Dabigatran is not recommended in patients with creatinine clearance
below 30 mL/min. More than 85% of the drug is eliminated by the renal route while the remaining
part via the enteral route. Acute renal failure can result in an unexpected increase in serum levels of
Dabigatran. In elderly, renal dysfunction, co-morbidity, and concomitant intake of different drugs
could make the dosage of Dabigatran challenging. We present a case of an elderly man who suffered
a severe accidental dabigatran intoxication with acute liver toxicity recovered after dialytic
treatment and Idarucizumab.
Keywords: Toxicity, direct thrombin inhibitor, dabigatran, idarucizumab, overdose, therapeutic drug monitoring.
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