A case of dabigatran-associated acute renal failure.

Dabigatran is a direct thrombin inhibitor that reduces the risk of systemic embolism in patients with nonvalvular atrial fibrillation. We report a case of an elderly man who developed unexplained rapid decline in renal function 6 weeks after starting dabigatran. A renal biopsy was planned to find out the etiology of acute renal failure, but the patient has significantly prolonged coagulation parameters despite holding medication for 5 days per manufacturer's recommendation. He was started on hemodialysis due to worsening renal function and to ensure dabigatran clearance before renal biopsy. Renal biopsy showed renal atheroembolic disease, which was possibly induced by dabigatran. Although renal atheroembolic disease is a known rare complication following treatment with warfarin, heparin, and thrombolytic agents, this is the first reported case of renal atheroembolic disease potentially caused by dabigatran. This case also highlights the extended duration of prolonged coagulation parameters after holding dabigatran and its implication for timing of nonemergent invasive procedures.

Cervical biopsy/cytology correlation data can be collected prospectively and shared clinically.

Cervical cytology (Cy) and biopsy (Bx) correlation is used by institutions for the evaluation of their cytodiagnostic capabilities as a part of overall laboratory quality improvement (QI). However, the data obtained from correlation are not routinely included in most surgical pathology (SP) reports. Our laboratory's procedure is to include the correlation of the patient's previous (most recent) cytology smear in the surgical pathology report of all/any gynecologic surgical pathology specimens. We reviewed this process for the time period between July 1998-June 1999. Any noncorrelating cases were assigned a correlation review code by the reviewing cytopathologist: major Cy diagnostic error (DE1), minor Cy diagnostic error (DE2), Cy sampling error (Cy SE), or biopsy sampling error (Bx SE). Of 3,486 cases reviewed, 3,229 cases were satisfactory for correlation studies. Concordant results were found in 86.9%. Cy DE1 due to either Cy screening or interpretation errors or both were found in 0.2% (n = 7) of all cases, while Cy DE2 due to the same were found in 1% (n = 32). Bx SE accounted for discrepancies in 6.8% (n = 220) of all cases, while 5.1% (n = 164) of the total cases were discrepancies due to Cy SE. Follow-up Bx was available in 97.2% (n = 214) of the Bx SE, and showed 16.4% (n = 35) to be major discrepancies and 83.6% (n = 179) to be minor discrepancies. Cervical Cy/Bx correlation is useful for the evaluation of a laboratory's QI. It is also useful for the identification of either Cy or Bx SE. While QI data exist as "internal use only" documents, SE data (as part of the CC (correlation comment) included in SP reports) are vital to a specific/given patient. Bx SE was identified in 6.3% of our patients, indicating a possible need for rebiopsy. This type of QI data may be shared clinically, and may direct the management for maximum diagnostic and patient benefit.