Dabigatran reversal

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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

  1. Local control measures: direct pressure
  2. Delay next 1-2 doses OR discontinue (as appropriate)

Moderate-Severe Bleeding

  1. Local control measures: direct pressure/surgical intervention
  2. Resuscitate with intravenous fluid and / blood products
  3. Oral charcoal administration if drug taken <2 hours before presentation
  4. Hemodialysis will remove ~60% of drug taken over prior 2-3 hours

Life-Threatening Bleeding

All of the above PLUS

  1. Consider Recombinant Factor VIIa (no good data)
  2. Consider Prothrombin Complex Concentrate (PCC): 50 IU/kg IV bolus (no good data)

Source

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

See Also

Warfarin (Coumadin) Reversal