Dabigatran reversal

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

See Also

• Coagulopathy (Main)

Source

• Hennepin County Guidelines
• University of Utah Healthcare Thrombosis Service Guidelines