Difference between revisions of "Dabigatran reversal"

(Reversal Protocol)
Line 6: Line 6:
 
#Mild Bleeding
 
#Mild Bleeding
 
##Local control measures
 
##Local control measures
##Delay next 1-2 dose OR discontinue as appropriate
+
##Delay next 1-2 doses OR discontinue (as appropriate)
 
#Moderate-Severe Bleeding
 
#Moderate-Severe Bleeding
 
##Local control measures/surgical intervention
 
##Local control measures/surgical intervention
##Symptomatic treatment
+
##IVF/blood
##Fluids/blood/monitoring
 
 
##Oral [[charcoal]] administration (if taken <2hrs before)
 
##Oral [[charcoal]] administration (if taken <2hrs before)
 
##Hemodialysis (removes 60% over 2-3hrs)
 
##Hemodialysis (removes 60% over 2-3hrs)

Revision as of 20:25, 15 November 2012

Background

  • If aPTT is normal (<1.5x control), it is unlikely that significant drug effect is present
  • Thrombin Time (TT) is most sensitive; normal TT excludes presence of significant dabigatran

Reversal Protocol

  1. Mild Bleeding
    1. Local control measures
    2. Delay next 1-2 doses OR discontinue (as appropriate)
  2. Moderate-Severe Bleeding
    1. Local control measures/surgical intervention
    2. IVF/blood
    3. Oral charcoal administration (if taken <2hrs before)
    4. Hemodialysis (removes 60% over 2-3hrs)
  3. Life-Threatening Bleeding
    1. All above
    2. Consider:
      1. rFVIIa
      2. Prothrombin Complex Concentrate (PCC); (Trad Name = Cofact)
        1. 50 IU/kg IV bolus

Source

  • Hennipin County Guidelines
  • University of Utah Healthcare Thrombosis Service Guidelines

See Also

Warfarin (Coumadin) Reversal