2017 Volume 39 Issue 4 Pages 304-308
An 84-year-old man who had been administered anticoagulants after a previous transient ischemic attack associated with non-valvular atrial fibrillation (NVAF) was referred to our hospital with epigastric pain, dysphagia, and hoarseness. These complaints appeared after changing the anticoagulant regimen from warfarin to dabigatran. Upper gastrointestinal endoscopy revealed esophageal mucosal injuries with the pathological finding of erosion. His symptoms improved within a day of switching anticoagulation medication from dabigatran to apixaban without a proton pump inhibitor. Three months after the switch to apixaban, a second upper gastrointestinal endoscopy showed clear improvement of the esophageal mucosal injuries. These findings allowed us to diagnose “dabigatran-induced esophagitis”. A small number of case reports have described dabigatran-induced esophagitis, but none have provided the details of subsequent anticoagulation therapy with another non-vitamin K antagonist oral anticoagulant. We thus demonstrate that switching medication from dabigatran to apixaban may offer an effective choice with minimum risk of embolism for NVAF patients who cannot take dabigatran because of digestive symptoms.
