Difference between revisions of "Dabigatran reversal"

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==Life-Threatening Bleeding==
 
==Life-Threatening Bleeding==
All of the above PLUS
+
*[[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 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 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 [[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>
* '''Idarucizumab(Praxbind)''': 5 grams IV (approved as of october 2015)
 
  
 
==See Also==
 
==See Also==

Revision as of 13:02, 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

In addition, consider above PLUS

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

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.