We report a case of acute onset of a biliary pancreatitis with cholangitis presented in our emergency department. The patient was under anticoagulant therapy with dabigatran due to persistent atrial fibrillation. Pancreatic enzymes including lipase were elevated above the linear measuring range and bilirubin together with cholestasis enzymes was also highly elevated. An ERCP with papillotomy was urgently indicated because postponing could lead to further deterioration of the patient's condition. Coagulation testing showed a prolonged thrombin time above 160sec which was followed by a diluted thrombin time (Haemoclot Test) resulted in a peak-level of dabigatran thus confirming full anticoagulation. Therefore, idarucizumab (Praxbind®) was administered pre-procedural of ERCP, the patient underwent uneventful ERCP without any bleeding complications, a full recovery was achieved and the patient was scheduled for elective cholecystectomy.
Keywords: anticoagulant therapy; biliary pancreatitis; bleeding; cholangitis.