Difference between revisions of "Dabigatran reversal"

(praxbind added)
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==See Also==
 
==See Also==
 
*[[Coagulopathy (Main)]]
 
*[[Coagulopathy (Main)]]
 +
*[[Idarucizumab]]
  
 
==References==
 
==References==

Revision as of 13:00, 14 December 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 FEIBA[1]
  • Consider Recombinant Factor VIIa (no good data)
  • Consider Kcentra (PCC): 50 IU/kg IV bolus[2]
  • Idarucizumab(Praxbind): 5 grams IV (approved as of october 2015)

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.