Dabigatran reversal: Difference between revisions
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==Life-Threatening Bleeding== | ==Life-Threatening Bleeding== | ||
All of the above PLUS | All of the above PLUS | ||
*Consider FEIBA<ref>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.</ref> | |||
*Consider Recombinant Factor VIIa (no good data) | *Consider Recombinant Factor VIIa (no good data) | ||
*Consider [[Prothrombin Complex Concentrate]] (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]] (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> | ||
Revision as of 10:37, 15 August 2015
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 FEIBA[1]
- Consider Recombinant Factor VIIa (no good data)
- Consider Prothrombin Complex Concentrate (PCC): 50 IU/kg IV bolus[2]
See Also
Source
- Hennepin County Guidelines
- University of Utah Healthcare Thrombosis Service Guidelines
- ↑ 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.