Difference between revisions of "Dabigatran reversal"

(Life-Threatening Bleeding)
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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<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>
  
 
==See Also==
 
==See Also==
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*Hennepin County Guidelines
 
*Hennepin County Guidelines
 
*University of Utah Healthcare Thrombosis Service Guidelines
 
*University of Utah Healthcare Thrombosis Service Guidelines
 +
 +
<references/>
  
 
[[Category:Heme/Onc]]
 
[[Category:Heme/Onc]]
 
[[Category:Drugs]]
 
[[Category:Drugs]]

Revision as of 14:01, 13 August 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

See Also

Source

  • Hennepin County Guidelines
  • University of Utah Healthcare Thrombosis Service Guidelines
  1. 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.