Administration of decapsulated dabigatran via nasogastric tube: A case report

In clinical practice, it is sometimes necessary to administer the thrombin inhibitor dabigatran etexilate (DE) to patients who have difficulty taking medications by mouth, but little is known about the pharmacokinetics and plasma concentrations of DE when it is administered via gavage. We describe a case in which it was necessary to orally administer the decapsulated contents of DE capsules.

A 79-year-old man with atrial fibrillation, quadriplegia, and a history of liver dysfunction who had difficulty swallowing was administered DE via a nasogastric tube while monitoring his plasma dabigatran concentration. To prepare the DE for administration, the contents of DE capsules were suspended in water. Despite administering only half the standard dose, the patient's blood dabigatran concentrations were comparable to those of patients receiving a full dose, potentially due to improved solubility and dispersion in the gastrointestinal tract after decapsulation. Coagulation status, as measured by activated partial thromboplastin time (aPTT), remained within safe limits, with no significant bleeding. DE was administered via a nasogastric tube for 8 days with monitoring.

This case suggests that, for patients who cannot take medication orally, DE can be administered safely via a nasogastric tube at lower doses while closely monitoring blood drug concentrations and aPTT levels. Further research is needed to explore the pharmacokinetics and understand the impact of diet on the absorption of DE administered via nasogastric tube. This administration method may broaden treatment options for atrial fibrillation in patients with difficulty in oral intake.