Difference between revisions of "Dabigatran reversal"

 
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==Background==
 
==Background==
*If aPTT is normal (<1.5x control), it is unlikely that significant drug effect is present
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*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==
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==Mild Bleeding==
#Mild Bleeding
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*Local control measures: direct pressure
##Local control measures
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*Delay next 1-2 doses '''OR''' discontinue (as appropriate)
##Delay next 1-2 dose OR discontinue as appropriate
 
#Moderate-Severe Bleeding
 
##Local control measures/surgical intervention
 
##Symptomatic treatment
 
##Fluids/blood/monitoring
 
##Oral [[charcoal]] administration (if taken <2hrs before)
 
##Hemodialysis (removes 60% over 2-3hrs)
 
#Life-Threatening Bleeding
 
##All above
 
##Consider:
 
###rFVIIa
 
###Prothrombin Complex Concentrate (PCC); (Trad Name = Cofact)
 
####50 IU/kg IV bolus
 
  
==Source==
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==[[hemorrhage|Moderate-Severe Bleeding]]==
*Hennipin County Guidelines
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*Local control measures: direct pressure/surgical intervention
*University of Utah Healthcare Thrombosis Service Guidelines
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*Resuscitate with intravenous [[IVF|fluid]] and / [[blood products]]
 +
*Oral [[charcoal]] administration ''if drug taken <2 hours before presentation''
 +
*[[Hemodialysis]] will remove ~60% of drug taken over prior 2-3 hours
 +
*Consider [[Idarucizumab]] ([[Praxbind]]): 5 grams IV
 +
 
 +
==[[hemorrhage|Life-Threatening Bleeding]]==
 +
*[[Idarucizumab]] (Praxbind): 5 grams IV
 +
 
 +
In addition, consider above PLUS
 +
*Consider FEIBA<ref>Dager WE, Gosselin RC, Roberts AJ. "Reversing dabigatran in life-threatening bleeding occurring during cardiac ablation with factor eight inhibitor bypassing activity". Crit Care Med. 2013 May;41(5):e42-6.</ref>
 +
*Consider Recombinant Factor VIIa (no good data)
 +
*Consider [[Prothrombin Complex Concentrate|Kcentra]] (PCC): 50 IU/kg IV bolus<ref>Eerenberg ES, et al. "Reversal of Rivaroxaban and Dabigatran by Prothrombin Complex Concentrate: A randomized, placebo-controlled, crossover study in healthy subjects".  Circulation. 2011 Sep 6.</ref>
 +
*Consider Tranexamic acid
  
 
==See Also==
 
==See Also==
[[Warfarin (Coumadin) Reversal]]
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*[[Coagulopathy (Main)]]
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*[[Idarucizumab]]
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*[[Anticoagulant reversal for life-threatening bleeds]]
 +
 
 +
==References==
 +
<references/>
  
 
[[Category:Heme/Onc]]
 
[[Category:Heme/Onc]]
[[Category:Drugs]]
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[[Category:Pharmacology]]

Latest revision as of 00:18, 1 October 2019

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

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

Moderate-Severe Bleeding

  • Local control measures: direct pressure/surgical intervention
  • Resuscitate with intravenous fluid and / blood products
  • Oral charcoal administration if drug taken <2 hours before presentation
  • Hemodialysis will remove ~60% of drug taken over prior 2-3 hours
  • Consider Idarucizumab (Praxbind): 5 grams IV

Life-Threatening Bleeding

In addition, consider above PLUS

  • Consider FEIBA[1]
  • Consider Recombinant Factor VIIa (no good data)
  • Consider Kcentra (PCC): 50 IU/kg IV bolus[2]
  • Consider Tranexamic acid

See Also

References

  1. Dager WE, Gosselin RC, Roberts AJ. "Reversing dabigatran in life-threatening bleeding occurring during cardiac ablation with factor eight inhibitor bypassing activity". Crit Care Med. 2013 May;41(5):e42-6.
  2. Eerenberg ES, et al. "Reversal of Rivaroxaban and Dabigatran by Prothrombin Complex Concentrate: A randomized, placebo-controlled, crossover study in healthy subjects". Circulation. 2011 Sep 6.