Dabigatran and Bleeding

13/9/11 PHARMAC Guidelines for management of bleeding with Dabigatran An Audit of bleeding events related to Dabigatran – Harper (2011)

- direct thrombin inhibitor - uses: (1) prophylaxis in orthropaedic surgery and (2) AF - dose = 150mg BD, 110mg BD (> 80 yrs) - t1/2 = 12-14 hours

Risk factors for bleeding

- elderly (>75 years) - renal impairment - low body weight

Starting Dabigatran

- wait for INR to be less than 2.0 - can only be used in AF not valve CVA prophylaxis

Bleeding management

- do coagulation screen - discuss with Haematology - stop Dabigatran - platelets if < 80 - TXA2: bolus 15-30mg/kg -> 1mg/kg/hr - oral charcoal if ingested within 2 hours - prothrombin X 25-50IU/kg - FVIIa 100mcg/kg - haemodialysis (particularly if in renal failure)