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Spontaneous hemothorax is a rare complication of dabigatran, a novel anticoagulant. This case highlights the importance of considering dabigatran withdrawal in patients presenting with unexplained hemothorax and acute kidney injury.

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Area of Science:

  • Cardiology
  • Nephrology
  • Pulmonology

Background:

  • Dabigatran is a direct thrombin inhibitor used for stroke prevention in nonvalvular atrial fibrillation.
  • Spontaneous hemothorax is an uncommon but serious adverse event associated with anticoagulant therapy.
  • Acute renal failure can be a complication of significant blood loss and hemodynamic instability.

Purpose of the Study:

  • To report a rare case of massive spontaneous hemothorax and acute renal failure in a patient treated with dabigatran.
  • To emphasize the need for clinical awareness of hemothorax as a potential complication of dabigatran therapy.

Main Methods:

  • Case report of an 83-year-old male patient.
  • Clinical presentation, diagnostic imaging (chest CT), laboratory findings, and therapeutic interventions were documented.
  • Diagnostic withdrawal of dabigatran and plasma transfusion were performed.

Main Results:

  • The patient developed massive spontaneous hemothorax and acute renal failure after 7 months of dabigatran therapy.
  • Ultrasound-guided thoracocentesis drained approximately 2500 mL of blood.
  • Discontinuation of dabigatran led to improvement in renal function and resolution of pleural effusion.

Conclusions:

  • Dabigatran was identified as the likely cause of spontaneous hemothorax and subsequent acute renal failure.
  • Clinicians should maintain a high index of suspicion for hemothorax in patients on dabigatran, especially with unexplained chest pain or dyspnea.
  • Prompt recognition and management, including drug withdrawal, are crucial for patient recovery.