Dabigatran reversal

Background

  • If aPTT is 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

See Also

Warfarin (Coumadin) Reversal