[Severe dabigatran intoxication complicated by insufficient reversal by idarucizumab]

Despite the emergence of the specific dabigatran antidote idarucizumab, reversal of dabigatran in the context of severe intoxication remains a clinical challenge. We report a case of severe intoxication secondary to acute renal failure in a 65-year-old man with atrial fibrillation. Idarucizumab was administered repeatedly but failed to reverse the effect of dabigatran, most likely due to ongoing redistribution. Full reversal of dabigatran was obtained through continuous haemodialysis over days. Further, secondary to the intoxication, the patient developed parenchymatous acute liver injury.