DOI: 10.1373/clinchem.2011.168393


A 77-year-old man was admitted to another hospital because of increasing dyspnea and edema of the lower limbs. The patient reported a loss of appetite and a flu-like illness 4 weeks previously. He was on various medications for heart failure, including metoprolol, ramipril, spironolactone, torasemide, metformin, and digoxin. For chronic atrial fibrillation, the patient had received dabigatran (75 mg twice per day) for 12 months; dabigatran is a direct thrombin inhibitor that has recently been cleared by the US Food and Drug Administration for the prevention of stroke in patients with atrial fibrillation.