Dabigatran reversal


  • 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


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