Abstract：
The direct-acting oral anticoagulant dabigatran etexilate (DE) targets thrombin and is used widely to prevent thromboembolism. A 79-year-old man was admitted to the Emergency Department due to anuria for 2 days. An urgent laboratory examination revealed a serum creatinine concentration of 888 µmol/L. He was diagnosed with acute exacerbation of chronic renal insufficiency. During continuous renal replacement therapy (CRRT), the coagulation test showed a severe reduction in the fibrinogen level as well as a significantly prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT). The patient had been taking DE (110 mg twice daily) for a long time and had not suspended the medication or reduced the dose during the worsening of anuria. Therefore, it should be evaluated before considering plasma replacement therapy for the patient, whether the abnormal coagulation parameters were induced by interference of excessive DE. Tentatively, we used activated charcoal to treat the plasma and then retested the fibrinogen, PT, and APTT. Results showed that the coagulation indices nearly returned to normal. The present case indicated that activated charcoal could adsorb DE in plasma effectively and eliminate its interference with coagulation test results, thereby providing support for clinical diagnosis and treatment.
摘要：
直接作用的口服抗凝剂达比加群etexilate（DE）靶向凝血酶，广泛用于预防血栓栓塞。一名79岁的男子因无尿2天被送往急诊科。紧急实验室检查显示血清肌酐浓度为888µmol/L。他被诊断为慢性肾功能不全急性加重。在连续性肾脏替代疗法（CRRT）期间，凝血试验显示纤维蛋白原水平显著降低,凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)显著延长.患者长期服用DE（每天两次110mg），并且在无尿恶化期间没有暂停药物或减少剂量。因此,在考虑对患者进行血浆替代疗法之前，应进行评估，凝血参数异常是否由过量DE的干扰引起。暂时，我们用活性炭处理血浆，然后重新测试纤维蛋白原，PT,和APTT。结果显示凝血指标基本恢复正常。结果表明，活性炭能有效吸附血浆中的DE，消除其对凝血试验结果的干扰。从而为临床诊断和治疗提供支持。
