Management of bleeding with dabigatran

Refer to algorithm

In the event of haemorrhagic complications associated with Dabigatran

• Discontinue dabigatran treatment and investigate the source of bleeding.
• 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 eg. 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.