Difference between revisions of "Dabigatran reversal"

Line 4: Line 4:
  
 
==Mild Bleeding==
 
==Mild Bleeding==
#Local control measures: direct pressure
+
*Local control measures: direct pressure
#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: direct pressure/surgical intervention
+
*Local control measures: direct pressure/surgical intervention
#Resuscitate with intravenous fluid and / blood products
+
*Resuscitate with intravenous fluid and / blood products
#Oral [[charcoal]] administration ''if drug taken <2 hours before presentation''
+
*Oral [[charcoal]] administration ''if drug taken <2 hours before presentation''
#Hemodialysis will remove ~60% of drug taken over prior 2-3 hours
+
*Hemodialysis will remove ~60% of drug taken over prior 2-3 hours
  
 
==Life-Threatening Bleeding==
 
==Life-Threatening Bleeding==
 
All of the above PLUS
 
All of the above PLUS
#Consider Recombinant Factor VIIa (no good data)
+
*Consider Recombinant Factor VIIa (no good data)
#Consider Prothrombin Complex Concentrate (PCC): 50 IU/kg IV bolus (no good data)
+
*Consider Prothrombin Complex Concentrate (PCC): 50 IU/kg IV bolus (no good data)
  
 
==See Also==
 
==See Also==

Revision as of 18:34, 29 May 2015

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

Life-Threatening Bleeding

All of the above PLUS

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

See Also

Source

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