A case of dabigatran-associated acute renal failure

Dabigatran is a direct thrombin inhibitor that reduces the risk of systemic embolism in patients with nonvalvular atrial fibrillation. We report a case of an elderly man who developed unexplained rapid decline in renal function 6 weeks after starting dabigatran. A renal biopsy was planned to find out the etiology of acute renal failure, but the patient has significantly prolonged coagulation parameters despite holding medication for 5 days per manufacturer's recommendation. He was started on hemodialysis due to worsening renal function and to ensure dabigatran clearance before renal biopsy. Renal biopsy showed renal atheroembolic disease, which was possibly induced by dabigatran. Although renal atheroembolic disease is a known rare complication following treatment with warfarin, heparin, and thrombolytic agents, this is the first reported case of renal atheroembolic disease potentially caused by dabigatran. This case also highlights the extended duration of prolonged coagulation parameters after holding dabigatran and its implication for timing of nonemergent invasive procedures.