{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T16:49:00Z","timestamp":1759942140680,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,7,30]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:p>A 58-year-old man presented with necrotising fasciitis and septic shock requiring urgent surgical debridement. Idarucizumab was used preoperatively to reverse the effects of dabigatran, which he was taking for chronic atrial fibrillation. He developed multiorgan failure including an oliguric acute kidney injury and was given continuous venovenous haemodiafiltration. Adjunctive intravenous immunoglobulin therapy was used in addition to his antibiotic therapy for necrotising fasciitis. Significant clinical and laboratory coagulopathy continued for over 12 days with evidence of a persistent dabigatran effect. Here, we discuss the potential impact of the immunoglobulin therapy, the patient\u2019s weight on the degree of redistribution of dabigatran seen and the oliguria in the context of an acute kidney injury on the apparent lack of the effectiveness of idarucizumab.<\/jats:p>","DOI":"10.1136\/bcr-2019-230125","type":"journal-article","created":{"date-parts":[[2019,8,22]],"date-time":"2019-08-22T05:17:53Z","timestamp":1566451073000},"page":"e230125","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Life-threatening bleeding due to persistent dabigatran effect in a patient with sepsis despite idarucizumab therapy and haemodialysis"],"prefix":"10.1136","volume":"12","author":[{"given":"Kathryn","family":"Humphries","sequence":"first","affiliation":[{"name":"Medicine, Waikato District Health Board, Hamilton, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Huggan","sequence":"additional","affiliation":[{"name":"Infectious Diseases and General Medicine, Waikato District Health Board, Hamilton, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Stiles","sequence":"additional","affiliation":[{"name":"Cardiology, Waikato District Health Board, Hamilton, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Martynoga","sequence":"additional","affiliation":[{"name":"Intensive Care and Anaesthetics, Waikato District Health Board, Hamilton, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,8,21]]},"reference":[{"key":"2025082700220897000_12.8.e230125.1","unstructured":"Boehinger Ingelheimer Pharmaceuticals. Pradaxa prescribing information, 2018."},{"key":"2025082700220897000_12.8.e230125.2","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2016.1.612"},{"key":"2025082700220897000_12.8.e230125.3","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-016-1275-8"},{"key":"2025082700220897000_12.8.e230125.4","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s13181-014-0448-6","article-title":"Enhanced elimination of dabigatran through extracorporeal methods","volume":"11","author":"Awad","year":"2015","journal-title":"J Med Toxicol"},{"key":"2025082700220897000_12.8.e230125.5","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.ajem.2016.09.050","article-title":"Idarucizumab, a specific reversal agent for dabigatran: mode of action, pharmacokinetics and pharmacodynamics, and safety and efficacy in phase 1 subjects","volume":"34","author":"Reilly","year":"2016","journal-title":"Am J Emerg Med"},{"key":"2025082700220897000_12.8.e230125.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1707278"},{"key":"2025082700220897000_12.8.e230125.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.07.104"},{"key":"2025082700220897000_12.8.e230125.8","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfv001"},{"key":"2025082700220897000_12.8.e230125.9","first-page":"1","article-title":"Use of continuous renal replacement therapy for removal of dabigatran in a patient in need of emergent surgery","volume":"2016","author":"Parli","year":"2016","journal-title":"Case Rep Crit Care"},{"key":"2025082700220897000_12.8.e230125.10","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s40262-016-0417-0","article-title":"Effect of age and renal function on idarucizumab pharmacokinetics and idarucizumab-mediated reversal of dabigatran anticoagulant activity in a randomized, double-blind, crossover Phase Ib Study","volume":"56","author":"Glund","year":"2017","journal-title":"Clin Pharmacokinet"},{"key":"2025082700220897000_12.8.e230125.11","unstructured":"Mueller BA , Golper TA . Drug removal in continuous renal replacement therapy. 2017. https:\/\/www.uptodate.com\/contents\/drug-removal-in-continuous-renal-replacement-therapy"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-230125","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:22:18Z","timestamp":1756279338000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-230125"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8]]},"references-count":11,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2019,8,21]]},"published-print":{"date-parts":[[2019,8]]}},"alternative-id":["10.1136\/bcr-2019-230125"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-230125","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,8]]}}}