Difference between revisions of "Dabigatran reversal"

(Reversal Protocol)
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==Background==
 
==Background==
*If aPTT is normal (<1.5x control), it is unlikely that significant drug effect is present
+
*If aPTT is <1.5 x control, it is unlikely that significant drug effect is present
 
*Thrombin Time (TT) is most sensitive; normal TT excludes presence of significant dabigatran
 
*Thrombin Time (TT) is most sensitive; normal TT excludes presence of significant dabigatran
  
==Reversal Protocol==
+
==Mild Bleeding==
#Mild Bleeding
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#Local control measures: direct pressure
##Local control measures
+
#Delay next 1-2 doses 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: direct pressure/surgical intervention
##IVF/blood
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#Resuscitate with intravenous fluid and / blood products
##Oral [[charcoal]] administration (if taken <2hrs before)
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#Oral [[charcoal]] administration ''if drug taken <2 hours before presentation''
##Hemodialysis (removes 60% over 2-3hrs)
+
#Hemodialysis will remove ~60% of drug taken over prior 2-3 hours
#Life-Threatening Bleeding
+
 
##All above
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==Life-Threatening Bleeding==
##Consider:
+
All of the above PLUS
###rFVIIa
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#Consider Recombinant Factor VIIa (no good data)
###Prothrombin Complex Concentrate (PCC); (Trad Name = Cofact)
+
#Consider Prothrombin Complex Concentrate (PCC): 50 IU/kg IV bolus (no good data)
####50 IU/kg IV bolus
 
  
 
==Source==
 
==Source==
*Hennipin County Guidelines
+
*Hennepin County Guidelines
 
*University of Utah Healthcare Thrombosis Service Guidelines
 
*University of Utah Healthcare Thrombosis Service Guidelines
  

Revision as of 19:23, 24 August 2013

Background

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

Mild Bleeding

  1. Local control measures: direct pressure
  2. Delay next 1-2 doses OR discontinue (as appropriate)

Moderate-Severe Bleeding

  1. Local control measures: direct pressure/surgical intervention
  2. Resuscitate with intravenous fluid and / blood products
  3. Oral charcoal administration if drug taken <2 hours before presentation
  4. Hemodialysis will remove ~60% of drug taken over prior 2-3 hours

Life-Threatening Bleeding

All of the above PLUS

  1. Consider Recombinant Factor VIIa (no good data)
  2. Consider Prothrombin Complex Concentrate (PCC): 50 IU/kg IV bolus (no good data)

Source

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

See Also

Warfarin (Coumadin) Reversal