Hematology
Contributions
Type: Publication Only
Background
Chronic anticoagulation is realized mainly with vitamin K antagonists (VKA), but the use of VKA is problematic in patients with severe lactose intolerance. Dabigatran is currently the only available lactose-free oral anticoagulant, however its use in patients with lactose intolerance has not been described.
Aims
Evaluate long-term anticoagulation with dabigatran in patients suffering lactose intolerance.
Methods
We present two patients with severe lactose intolerance on long-term anticoagulation with VKA, that were transitioned from VKA to dabigatran because the treatment with VKA worsened symptoms of their lactose intolerance.Case 1. A 75-year-old female was diagnosed with nonvalvular atrial fibrillation. Long-term anticoagulation with VKA was started for stroke prevention. Two weeks later, the patient was admitted by recurrence of acute diarrhea in the setting of her lactose intolerance, well controlled so far. VKA was replaced by dabigatran and fifteen months later, she remains asymptomatic.Case 2. A 40-year-old female was diagnosed with antiphospholipid syndrome (APS) when she experienced a non provocated acute left upper extremity venous thrombosis. She was started on anticoagulation with VKA with an INR target of 2.5 and had no recurrence of thrombosis. However, VKA therapy was complicated by frequent episodes of diarrhea that the patient suffered from several years. She was evaluated by a gastroenterologist and was diagnosed with lactose intolerance. Due to progressive worsening gastrointestinal clinical despite a lactose free diet, three years later she was transitioned from VKA to dabigatran. One year later, she is asymptomatic and has not suffered thromboembolic recurrence.
We present two patients with severe lactose intolerance on long-term anticoagulation with VKA, that were transitioned from VKA to dabigatran because the treatment with VKA worsened symptoms of their lactose intolerance.
Case 1. A 75-year-old female was diagnosed with nonvalvular atrial fibrillation. Long-term anticoagulation with VKA was started for stroke prevention. Two weeks later, the patient was admitted by recurrence of acute diarrhea in the setting of her lactose intolerance, well controlled so far. VKA was replaced by dabigatran and fifteen months later, she remains asymptomatic.
Case 2. A 40-year-old female was diagnosed with antiphospholipid syndrome (APS) when she experienced an unprovoked acute left upper extremity venous thrombosis. She was started on anticoagulation with VKA with an INR target of 2.5 and had no recurrence of thrombosis. However, VKA therapy was complicated by frequent episodes of diarrhea that the patient suffered from several years earlier. She was evaluated by a gastroenterologist and was diagnosed with lactose intolerance. Due to progressive worsening gastrointestinal clinical despite a lactose free diet, three years later she was transitioned from VKA to dabigatran. One year later, she is asymptomatic and has not suffered thromboembolic recurrence.
Results
Our patients with lactose intolerance on long-term anticoagulation with dabigatran have not experienced gastrointestinal symptoms or thromboembolic complications months after transitioning to dabigatran.
Summary
Switching from VKA to dabigatran for patients with lactose intolerance seemed clinically reasonable, but until results of prospective randomised trials are available, we recommend caution in using dabigatran in patients with APS.
Keyword(s): Anticoagulants, Antiphospholipid syndrome, Direct thrombin inhibitor, Thromboembolic events
Session topic: Publication Only
Type: Publication Only
Background
Chronic anticoagulation is realized mainly with vitamin K antagonists (VKA), but the use of VKA is problematic in patients with severe lactose intolerance. Dabigatran is currently the only available lactose-free oral anticoagulant, however its use in patients with lactose intolerance has not been described.
Aims
Evaluate long-term anticoagulation with dabigatran in patients suffering lactose intolerance.
Methods
We present two patients with severe lactose intolerance on long-term anticoagulation with VKA, that were transitioned from VKA to dabigatran because the treatment with VKA worsened symptoms of their lactose intolerance.Case 1. A 75-year-old female was diagnosed with nonvalvular atrial fibrillation. Long-term anticoagulation with VKA was started for stroke prevention. Two weeks later, the patient was admitted by recurrence of acute diarrhea in the setting of her lactose intolerance, well controlled so far. VKA was replaced by dabigatran and fifteen months later, she remains asymptomatic.Case 2. A 40-year-old female was diagnosed with antiphospholipid syndrome (APS) when she experienced a non provocated acute left upper extremity venous thrombosis. She was started on anticoagulation with VKA with an INR target of 2.5 and had no recurrence of thrombosis. However, VKA therapy was complicated by frequent episodes of diarrhea that the patient suffered from several years. She was evaluated by a gastroenterologist and was diagnosed with lactose intolerance. Due to progressive worsening gastrointestinal clinical despite a lactose free diet, three years later she was transitioned from VKA to dabigatran. One year later, she is asymptomatic and has not suffered thromboembolic recurrence.
We present two patients with severe lactose intolerance on long-term anticoagulation with VKA, that were transitioned from VKA to dabigatran because the treatment with VKA worsened symptoms of their lactose intolerance.
Case 1. A 75-year-old female was diagnosed with nonvalvular atrial fibrillation. Long-term anticoagulation with VKA was started for stroke prevention. Two weeks later, the patient was admitted by recurrence of acute diarrhea in the setting of her lactose intolerance, well controlled so far. VKA was replaced by dabigatran and fifteen months later, she remains asymptomatic.
Case 2. A 40-year-old female was diagnosed with antiphospholipid syndrome (APS) when she experienced an unprovoked acute left upper extremity venous thrombosis. She was started on anticoagulation with VKA with an INR target of 2.5 and had no recurrence of thrombosis. However, VKA therapy was complicated by frequent episodes of diarrhea that the patient suffered from several years earlier. She was evaluated by a gastroenterologist and was diagnosed with lactose intolerance. Due to progressive worsening gastrointestinal clinical despite a lactose free diet, three years later she was transitioned from VKA to dabigatran. One year later, she is asymptomatic and has not suffered thromboembolic recurrence.
Results
Our patients with lactose intolerance on long-term anticoagulation with dabigatran have not experienced gastrointestinal symptoms or thromboembolic complications months after transitioning to dabigatran.
Summary
Switching from VKA to dabigatran for patients with lactose intolerance seemed clinically reasonable, but until results of prospective randomised trials are available, we recommend caution in using dabigatran in patients with APS.
Keyword(s): Anticoagulants, Antiphospholipid syndrome, Direct thrombin inhibitor, Thromboembolic events
Session topic: Publication Only