Following is a comment I received about one reader’s experience with this drug. Why don’t we just set some hard parameters or age limits on the use of such drugs? I’ll provide the opposing view tomorrow.
“So far, one clinical trauma experience- 70+ yo male cut his fingers working with a model airplane engine; on dabigatran. Blood loss nearly 1 L., no control of bleeding w. 2 hours of tourniquet time. Required microvascular ligation of digital vessels. Impressively powerful anticoagulant.
You have to be aware of dosing times to know how long anti-coag effect is likely to endure. Lab tests of little help. No demonstrated efficiacy of Factor VIIa or PCC; in fact, PCC has been shown not to help in one trial. It is effective with Xarelto, though.
Our blood bank stays up at night worrying about this drug, with good reason, since we do our own collections.
Clinicians prescribing this drug should look at bleeding risk scoring systems (HEMORR2HAGE, HAS-BLED) as well as the CHADS2 score before deciding to use this drug.
I suspect it will be ultimately replaced by the Factor Xa inhibitors.
N.B- New Zealand has been reporting a myriad of bleeding issues with this drug. Since it is a relatively closed system, their experience should be a bellweather.”
Trauma Program Director