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Area of Science:

  • Cardiology
  • Pulmonology
  • Pharmacology

Background:

  • Anticoagulation therapy is crucial for preventing and treating thromboembolic events.
  • Direct oral anticoagulants (DOACs) like dabigatran are commonly prescribed for various indications.
  • Despite anticoagulation, breakthrough thromboembolic events can occur.

Observation:

  • A 44-year-old female presented with shortness of breath.
  • Diagnostic workup revealed bilateral pulmonary emboli (PE).
  • The patient was concurrently taking dabigatran for anticoagulation.

Findings:

  • The occurrence of bilateral PE in a patient receiving dabigatran highlights a potential failure or limitation of anticoagulation.
  • This case underscores the need for vigilance in diagnosing PE, even in patients on anticoagulant therapy.
  • Further investigation may be warranted to understand the specific factors contributing to this event.

Implications:

  • Clinicians must maintain a high index of suspicion for pulmonary embolism in patients presenting with relevant symptoms, irrespective of their anticoagulation status.
  • This case may prompt a review of anticoagulation protocols and monitoring strategies for DOACs.
  • It emphasizes the importance of considering alternative or adjunctive therapies in high-risk patients or those with breakthrough events.