BMJ Case Reports 2013; doi:10.1136/bcr-2013-009139

Severe necrotic oesophageal and gastric ulceration associated with dabigatran

  1. Cherian Thomas2
  1. 1Department of Surgery, Barnet and Chase Farm Hospitals Trust, London, UK
  2. 2Department of Radiology, Barnet and Chase Farm Hospitals Trust, London, UK
  1. Correspondence to Dr Saurabh Singh, saurabh.singh{at}


A 69-year-old Caucasian man, who had been discharged 2 days previously, 5 days post-elective right total hip replacement, was re-admitted with a 16 h history of coffee-ground vomiting and epigastric pain. He had been discharged with 220 mg dabigatran, a novel oral anticoagulant. The coffee-ground vomiting started within minutes of taking the first dose. Haemodynamic compromise, agitation, decreasing conscious level and aspiration pneumonia necessitated intubation, ventilation and inotropic support in the intensive care unit. A CT on admission showed extensive intramural air seen within the lower oesophagus and a dilated stomach, duodenum and jejunum. Endoscopy of the upper gastrointestinal tract showed extensive ulceration, sloughing and multiple areas of necrosis in the distal oesophagus and stomach. The patient made a fully recovery with supportive management.

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