A 69-year-old man with atrial fibrillation developed acute hepatitis 2 weeks after initiating dabigatran 110 mg twice daily, which resolved upon discontinuation.
Case Report (n=1)
Does dabigatran cause acute hepatitis in patients with atrial fibrillation?
Dabigatran can rarely cause acute hepatitis, and clinicians should monitor hepatic function, especially when co-administered with P-glycoprotein inhibitors like ticagrelor.
Abstract Background Dabigatran etexilate is a prodrug converted into active dabigatran, a reversible thrombin inhibitor, after oral administration. The Food and Drug Administration approved it for stroke prevention in non-valvular atrial fibrillation patients and for treating deep venous thrombosis and pulmonary embolism. In the Randomized Evaluation of Long-Term Anticoagulation Therapy trial, dabigatran demonstrated non-inferior efficacy and reduced hemorrhagic stroke risk compared with warfarin. Herein, we present a rare case of a patient with atrial fibrillation who developed acute hepatitis following dabigatran initiation. Case Summary A 69-year-old man with a history of hypertension, diabetes, and recent non-ST elevation acute coronary syndrome underwent drug-eluting stent placement in October 2024. He was discharged on antiplatelets, heart failure, and diabetes therapies. On November 12, 2024, dabigatran 110 mg twice daily was added for atrial fibrillation stroke prevention, discontinuing aspirin. Two weeks later, the patient presented with decreased appetite, epigastric discomfort, dark urine, weight loss, and constipation. Laboratory tests revealed elevated hepatic enzymes, excluding viral and other etiologies. After discontinuing dabigatran, the liver enzymes normalized during hospitalization. He was discharged on December 11, 2024, and his anticoagulant was switched to edoxaban during the follow-up visit a week later. Liver function remained normal since then. Discussion This case highlights drug-induced liver injury (DILI) rarely attributed to dabigatran, despite proper dosing. Notably, ticagrelor, a P-glycoprotein (P-gp) inhibitor was concurrently administered, which might have increased dabigatran exposure, contributing to hepatotoxicity. Clinicians should remain vigilant for DILI in patients on dabigatran—particularly those on P-gp inhibitors—and monitor hepatic function.
Hsu et al. (Fri,) conducted a case report in Atrial fibrillation (n=1). Dabigatran was evaluated on Acute hepatitis. A 69-year-old man with atrial fibrillation developed acute hepatitis 2 weeks after initiating dabigatran 110 mg twice daily, which resolved upon discontinuation.