Dabigatran reversal: Difference between revisions

 
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==Background==
==Background==
*If aPTT is normal (<1.5x control), it is unlikely that significant drug effect is present
*Brand name Pradaxa
*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


==Reversal Protocol==
==Mild Bleeding==
#Mild Bleeding
*Local control measures: direct pressure
##Local control measures
*Delay next 1-2 doses '''OR''' discontinue (as appropriate)
##Delay next 1-2 doses OR discontinue (as appropriate)
#Moderate-Severe Bleeding
##Local control measures/surgical intervention
##IVF/blood
##Oral [[charcoal]] administration (if taken <2hrs before)
##Hemodialysis (removes 60% over 2-3hrs)
#Life-Threatening Bleeding
##All above
##Consider:
###rFVIIa
###Prothrombin Complex Concentrate (PCC); (Trad Name = Cofact)
####50 IU/kg IV bolus


==Source==
==[[hemorrhage|Moderate-Severe Bleeding]]==
*Hennipin County Guidelines
*Local control measures: direct pressure/surgical intervention
*University of Utah Healthcare Thrombosis Service Guidelines
*Resuscitate with intravenous [[IVF|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
 
==[[hemorrhage|Life-Threatening Bleeding]]==
*[[Idarucizumab]] (Praxbind): 5 grams IV
 
In addition, consider 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 [[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==
[[Warfarin (Coumadin) Reversal]]
*[[Coagulopathy (Main)]]
*[[Anticoagulants]]
*[[Idarucizumab]]
*[[Anticoagulant reversal for life-threatening bleeds]]
 
==References==
<references/>


[[Category:Heme/Onc]]
[[Category:Heme/Onc]]
[[Category:Drugs]]
[[Category:Pharmacology]]

Latest revision as of 18:16, 16 September 2021

Background

  • Brand name Pradaxa
  • 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

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

  1. 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.
  2. 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.