Four cases of hemorrhagic herpes zoster associated with dabigatran therapy

Abstract

In 2015, we reported three patients in therapy with clopidogrel who developed hemorrhagic herpes zoster (HHZ). 1 In the last months, we observed four patients with HHZ who were in therapy with dabigatran, an oral anticoagulant. This drug acts by inhibiting free and fibrin-bound thrombin. 2 It was initially approved to prevent embolisms in patients with non-valvular atrial fibrillation. 2 Dabigatran showed to be effective and well tolerated: esophagitis, gastrointestinal hemorrhages, myocardial infarction, hepatitis, nephritis and allergic reactions are rare side effects. 2 Furthermore, coagulation monitoring is unnecessary. 2 To our knowledge, only one case 3 of HHZ associated with dabigatran therapy was reported in the literature.The patients were four Caucasian females aged 73, 69, 85, and 69 years, respectively, in therapy with dabigatran (150-220 mg/day) for 3-8 weeks. Two patients were subjected to recent hip or knee arthroplasty; two patients were affected by peripheral arterial dis-