Dabigatran reversal

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

See Also

Warfarin (Coumadin) Reversal