Dabigatran – Protocol for Management of Bleeding – NHS Borders

Protocol for Management of Bleeding with Dabigatran

In the event of haemorrhagic complications associated with Dabigatran:

·      Discontinue dabigatran treatment immediately and investigate the source and severity of bleeding.

·      Initiate standard resuscitation and haemostatic measures

·      Record the dose and time of the last dabigatran dose, renal function, concurrent antiplatelet or anticoagulant therapy, and indication for anticoagulation.

·      Consideration should also be given to administration of platelet concentrates if thrombocytopenia is present or long-acting antiplatelet drugs have been used.

·      Initiate appropriate clinical support e.g. Surgical or local haemostasis, transfusion of red cells, volume substitution, inotropic drugs.

·      When rapid reversal of the anticoagulant effect is required, Idarucizumab (Praxbind) is available in BGH

·      Consult haematology if bleeding is moderate to severe or life-threatening.

Consider:

·      Dabigatran is primarily eliminated in the urine – maintain adequate diuresis.

·      The APTT can be used as a qualitative marker of dabigatran activity – if the APTT is normal dabigatran is unlikely to be present.

·      Dabigatran has low protein binding and can be dialysed; it may take 6-8 hours to clear dabigatran this way and limited data supports this approach. The best guide for duration of dialysis is normalisation of the APTT and/or shortening of the thrombin clotting time to 60 seconds or less.

·      Absorption of dabigatran can be prevented by the administration of activated charcoal, which adsorbs toxic substances and reduces or prevents systematic absorption, within 2 hours of ingestion of dabigatran.