# Normalization of Activated Partial Thromboplastin Time Correlates with Low Levels of Dabigatran in a Patient with Severe Sepsis

## TL;DR

A patient with severe sepsis and kidney failure had their blood clotting levels improve after hemodialysis removed the anticoagulant dabigatran.

## Contribution

Demonstrates that hemodialysis can effectively reduce dabigatran levels in patients with severe sepsis and renal failure.

## Key findings

- Normalization of activated partial thromboplastin time occurred after hemodialysis.
- Dabigatran levels were significantly reduced following continuous venovenous hemofiltration.
- The patient's coagulopathy improved sufficiently to allow surgery.

## Abstract

The oral anticoagulant dabigatran etexilate can be a challenge when patients need acute surgery. Sepsis and acute renal failure exacerbate the anticoagulant effect. There is no specific reversal agent for dabigatran etexilate, but it can be removed by hemodialysis. We present a case where a patient treated with dabigatran etexilate was admitted to intensive care unit with severe sepsis and acute renal failure and in need of bilateral lower limp amputation due to ischemia. The patient had severe coagulopathy and was treated with continuous venovenous hemofiltration in attempt to remove dabigatran etexilate before surgery.