Difference between revisions of "Dabigatran reversal"

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==Background==
 
==Background==
*If aPTT is totally normal (<1.5x), unlikely that significant drug effect is present
+
*If aPTT is totally normal (<1.5x control), it is unlikely that significant drug effect is present
 +
*Thrombin Time (TT) is most sensitive; normal TT excludes presence of significant dabigatran
  
 
==Reversal Protocol==
 
==Reversal Protocol==
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#Life-Threatening Bleeding
 
#Life-Threatening Bleeding
 
##All above
 
##All above
##Consider
+
##Consider:
 
###rFVIIa
 
###rFVIIa
###PCC
+
###Prothrombin Complex Concentrate (PCC); (Trad Name = Cofact)
 +
####50 IU/kg IV bolus
  
 
==Source==
 
==Source==

Revision as of 18:21, 9 June 2012

Background

  • If aPTT is totally normal (<1.5x control), it is unlikely that significant drug effect is present
  • Thrombin Time (TT) is most sensitive; normal TT excludes presence of significant dabigatran

Reversal Protocol

  1. Mild Bleeding
    1. Local control measures
    2. Delay next 1-2 dose OR discontinue as appropriate
  2. Moderate-Severe Bleeding
    1. Local control measures/surgical intervention
    2. Symptomatic treatment
    3. Fluids/blood/monitoring
    4. Oral charcoal administration (if taken <2hrs before)
    5. Hemodialysis (removes 60% over 2-3hrs)
  3. Life-Threatening Bleeding
    1. All above
    2. Consider:
      1. rFVIIa
      2. Prothrombin Complex Concentrate (PCC); (Trad Name = Cofact)
        1. 50 IU/kg IV bolus

Source

Hennipin County Guidelines University of Utah Healthcare Thrombosis Service Guidelines