Dabigatran reversal: Difference between revisions
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==Mild Bleeding== | ==Mild Bleeding== | ||
*Local control measures: direct pressure | *Local control measures: direct pressure | ||
*Delay next 1-2 doses OR discontinue (as appropriate) | *Delay next 1-2 doses '''OR''' discontinue (as appropriate) | ||
==Moderate-Severe Bleeding== | ==[[hemorrhage|Moderate-Severe Bleeding]]== | ||
*Local control measures: direct pressure/surgical intervention | *Local control measures: direct pressure/surgical intervention | ||
*Resuscitate with intravenous fluid and / blood products | *Resuscitate with intravenous [[IVF|fluid]] and / [[blood products]] | ||
*Oral [[charcoal]] administration ''if drug taken <2 hours before presentation'' | *Oral [[charcoal]] administration ''if drug taken <2 hours before presentation'' | ||
*Hemodialysis will remove ~60% of drug taken over prior 2-3 hours | *[[Hemodialysis]] will remove ~60% of drug taken over prior 2-3 hours | ||
*Consider [[Idarucizumab]] ([[Praxbind]]): 5 grams IV | *Consider [[Idarucizumab]] ([[Praxbind]]): 5 grams IV | ||
==Life-Threatening Bleeding== | ==[[hemorrhage|Life-Threatening Bleeding]]== | ||
*[[Idarucizumab]] (Praxbind): 5 grams IV | *[[Idarucizumab]] (Praxbind): 5 grams IV | ||
| Line 21: | Line 21: | ||
*Consider Recombinant Factor VIIa (no good data) | *Consider Recombinant Factor VIIa (no good data) | ||
*Consider [[Prothrombin Complex Concentrate|Kcentra]] (PCC): 50 IU/kg IV bolus<ref>Eerenberg ES, et al. "Reversal of Rivaroxaban and Dabigatran by Prothrombin Complex Concentrate: A randomized, placebo-controlled, crossover study in healthy subjects". Circulation. 2011 Sep 6.</ref> | *Consider [[Prothrombin Complex Concentrate|Kcentra]] (PCC): 50 IU/kg IV bolus<ref>Eerenberg ES, et al. "Reversal of Rivaroxaban and Dabigatran by Prothrombin Complex Concentrate: A randomized, placebo-controlled, crossover study in healthy subjects". Circulation. 2011 Sep 6.</ref> | ||
*Consider Tranexamic acid | |||
==See Also== | ==See Also== | ||
*[[Coagulopathy (Main)]] | *[[Coagulopathy (Main)]] | ||
*[[Idarucizumab]] | *[[Idarucizumab]] | ||
*[[Anticoagulant reversal for life-threatening bleeds]] | |||
==References== | ==References== | ||
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[[Category:Heme/Onc]] | [[Category:Heme/Onc]] | ||
[[Category: | [[Category:Pharmacology]] | ||
Revision as of 00:18, 1 October 2019
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
- Consider Idarucizumab (Praxbind): 5 grams IV
Life-Threatening Bleeding
- Idarucizumab (Praxbind): 5 grams IV
In addition, consider above PLUS
- Consider FEIBA[1]
- Consider Recombinant Factor VIIa (no good data)
- Consider Kcentra (PCC): 50 IU/kg IV bolus[2]
- Consider Tranexamic acid
See Also
References
- ↑ Dager WE, Gosselin RC, Roberts AJ. "Reversing dabigatran in life-threatening bleeding occurring during cardiac ablation with factor eight inhibitor bypassing activity". Crit Care Med. 2013 May;41(5):e42-6.
- ↑ Eerenberg ES, et al. "Reversal of Rivaroxaban and Dabigatran by Prothrombin Complex Concentrate: A randomized, placebo-controlled, crossover study in healthy subjects". Circulation. 2011 Sep 6.