Question

What are your top 2 concerns for the use of Dabigatran in Doreen? Do NOT choose grapefruit juice. Explain your choice for each and provide one nursing intervention for each concern. Do NOT select grapefruit juice as it is in the next question (4 marks).

CASE STUDY:

Doreen is a 48-year old woman of Hispanic with a history of peptic ulcer disease. Doreen eats a diet high in green leafy vegetables and enjoys green tea and grapefruit juice occasionally.Yesterday Doreen began experiencing severe pain in her calf; today the pain is worse so Doreen has come to the Emergency Room. Doreen’s lower leg is red, swollen and painful to the touch. Doreen is diagnosed with Deep Vein Thrombosis for which she is prescribed Dabigatran 150 mg BID; genetic testing is done and it is determined that Doreen has a wild type genotype for CYP 2C9. Doreen’s vitals are: BP – 100/60; HR – 110; RR – 18; T – 37. Doreen reports that she often takes Acetaminophen for headaches. Doreen’s CrCl rate is 40 mL/min and her weight is 59 kg

Answer 1

My first concern in this case is, she has a history of peptic ulcer disease and starting her on an anticoagulant (dabigatran) could increase the risk of G.I bleeding. nursing intervention is to check for melena to rule out any upper G.I bleeding.

my second concern is her low blood pressure and tachycardia ( heart rate 110 bpm) that is common in atrial fibrillation so the nursing intervention would be looking at her E.C.G(echocardiogram) to rule out any other cardiac abnormalities.

As she has wild type genotype for CYP 2C9 we should check the other medicines(if any) as some drugs could be CYP inducers or inhibitors or substrates.