Dabigatran reversal: Difference between revisions
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==Background== | ==Background== | ||
*If aPTT is | *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 | *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) | |||
==Source== | ==Source== | ||
* | *Hennepin County Guidelines | ||
*University of Utah Healthcare Thrombosis Service Guidelines | *University of Utah Healthcare Thrombosis Service Guidelines | ||
Revision as of 19:23, 24 August 2013
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
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)
Source
- Hennepin County Guidelines
- University of Utah Healthcare Thrombosis Service Guidelines