{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T23:05:34Z","timestamp":1774566334155,"version":"3.50.1"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T00:00:00Z","timestamp":1769817600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100022298","name":"Hualien Tzu Chi Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022298","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005925","name":"Buddhist Tzu Chi Medical Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dabigatran etexilate is a prodrug converted into active dabigatran, a reversible thrombin inhibitor, after oral administration. The Food and Drug Administration approved it for stroke prevention in non-valvular atrial fibrillation patients and for treating deep venous thrombosis and pulmonary embolism. In the Randomized Evaluation of Long-Term Anticoagulation Therapy trial, dabigatran demonstrated non-inferior efficacy and reduced haemorrhagic stroke risk compared with warfarin. Herein, we present a rare case of a patient with atrial fibrillation who developed acute hepatitis following dabigatran initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 69-year-old man with a history of hypertension, diabetes, and recent non-ST elevation acute coronary syndrome underwent drug-eluting stent placement in October 2024. He was discharged on antiplatelets, heart failure, and diabetes therapies. On 12 November 2024, dabigatran 110\u202fmg twice daily was added for atrial fibrillation stroke prevention, discontinuing aspirin. Two weeks later, the patient presented with decreased appetite, epigastric discomfort, dark urine, weight loss, and constipation. Laboratory tests revealed elevated hepatic enzymes, excluding viral and other aetiologies. After discontinuing dabigatran, the liver enzymes normalized during hospitalization. He was discharged on 11 December 2024, and his anticoagulant was switched to edoxaban during the follow-up visit a week later. Liver function remained normal since then.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case highlights drug-induced liver injury (DILI) rarely attributed to dabigatran, despite proper dosing. Notably, ticagrelor, a P-glycoprotein (P-gp) inhibitor, was concurrently administered, which might have increased dabigatran exposure, contributing to hepatotoxicity. Clinicians should remain vigilant for DILI in patients on dabigatran\u2014particularly those on P-gp inhibitors\u2014and monitor hepatic function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag081","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T12:41:21Z","timestamp":1769776881000},"source":"Crossref","is-referenced-by-count":1,"title":["Dabigatran-induced acute hepatitis in a patient with atrial fibrillation: a rare case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2915-9827","authenticated-orcid":false,"given":"Chih-Wei","family":"Hsu","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation , No. 707, Sec. 3, Zhongyang Road, Hualien City, Hualien County 970473 ,","place":["Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huai-Ren","family":"Chang","sequence":"additional","affiliation":[{"name":"School of Medicine, Tzu Chi University , No. 701, Sec. 3, Zhongyang Road, Hualien City, Hualien County 970374 ,","place":["Taiwan"]},{"name":"Division of Cardiology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation , No. 707, Sec. 3, Zhongyang Road, Hualien City, Hualien County 970473 ,","place":["Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4679-5856","authenticated-orcid":false,"given":"Shan-Chieh","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation , No. 707, Sec. 3, Zhongyang Road, Hualien City, Hualien County 970473 ,","place":["Taiwan"]},{"name":"Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University , No. 33, Linsen S. Road, Zhongzheng District, Taipei City 100025 ,","place":["Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,1,31]]},"reference":[{"key":"2026021807165948900_ytag081-B1","doi-asserted-by":"crossref","first-page":"426","DOI":"10.3174\/ajnr.A3000","article-title":"Dabigatran (pradaxa)","volume":"33","author":"Comin","year":"2012","journal-title":"AJNR Am J Neuroradiol"},{"key":"2026021807165948900_ytag081-B2","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1161\/CIRCULATIONAHA.110.004424","article-title":"Dabigatran etexilate: a new oral thrombin inhibitor","volume":"123","author":"Hankey","year":"2011","journal-title":"Circulation"},{"key":"2026021807165948900_ytag081-B3","first-page":"405","article-title":"More indications approved and safety news for dabigatran etexilate","volume":"9","author":"Cinteza","year":"2014","journal-title":"Maedica (Bucur)"},{"key":"2026021807165948900_ytag081-B4","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1056\/NEJMoa0905561","article-title":"Dabigatran versus warfarin in patients with atrial fibrillation","volume":"361","author":"Connolly","year":"2009","journal-title":"N Engl J Med"},{"key":"2026021807165948900_ytag081-B5","doi-asserted-by":"crossref","first-page":"e938","DOI":"10.1016\/S2352-3026(24)00281-3","article-title":"Changes in the landscape of anticoagulation: a focus on direct oral anticoagulants","volume":"11","author":"Ageno","year":"2024","journal-title":"Lancet Haematol"},{"key":"2026021807165948900_ytag081-B6"},{"key":"2026021807165948900_ytag081-B7","doi-asserted-by":"crossref","first-page":"841","DOI":"10.4254\/wjh.v15.i6.841","article-title":"Liver injury from direct oral anticoagulants","volume":"15","author":"Juneja","year":"2023","journal-title":"World J Hepatol"},{"key":"2026021807165948900_ytag081-B8","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1136\/heartjnl-2013-305288","article-title":"Risk of drug-induced liver injury with the new oral anticoagulants: systematic review and meta-analysis","volume":"100","author":"Caldeira","year":"2014","journal-title":"Heart"},{"key":"2026021807165948900_ytag081-B9","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1093\/eurheartj\/ehr488","article-title":"Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish atrial fibrillation cohort study","volume":"33","author":"Friberg","year":"2012","journal-title":"Eur Heart J"},{"key":"2026021807165948900_ytag081-B10","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur Heart J"},{"key":"2026021807165948900_ytag081-B11","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/0895-4356(93)90101-6","article-title":"Causality assessment of adverse reactions to drugs\u2013I. A novel method based on the conclusions of international consensus meetings: application to drug-induced liver injuries","volume":"46","author":"Danan","year":"1993","journal-title":"J Clin Epidemiol"},{"key":"2026021807165948900_ytag081-B12"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytag081\/66671283\/ytag081.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/2\/ytag081\/66671283\/ytag081.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/2\/ytag081\/66671283\/ytag081.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T12:17:04Z","timestamp":1771417024000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytag081\/8449767"}},"subtitle":[],"editor":[{"given":"Christian-Hendrik Hendrik","family":"Heeger","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Thomas","family":"Fink","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Feickert","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Deepti","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,1,31]]},"references-count":12,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytag081","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2026,1,31]]},"article-number":"ytag081"}}