- 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
- Local control measures: direct pressure
- Delay next 1-2 doses OR discontinue (as appropriate)
- 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
All of the above PLUS
- Consider FEIBA
- Consider Recombinant Factor VIIa (no good data)
- Consider Kcentra (PCC): 50 IU/kg IV bolus
- Idarucizumab(Praxbind): 5 grams IV (approved as of october 2015)
- 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.