Finally, a consensus report has been finalized by the Institute for Clinical Systems Improvement (ICSI) regarding bleeding in patients taking dabigatran (Pradaxa). I’ve written about the special problems posed by patients who are injured while taking this drug and related ones. I’ve also provided some management algorithms for consideration while complete ones were crafted. Well, here they are.
A workgroup of experts from hospitals here in Minnesota were convened to consider and provide a framework for managing these patients. A document was released recently to help guide their care.
To summarize, patients who experience a severe bleed, say from trauma, should be managed with:
- Holding the medication
- Evaluating bleeding. In trauma, this will generally involve CT scan.
- Consider the need for surgery
- Give activated charcoal if the drug was taken within 2 hours
- Consider dialysis
- Transfuse blood if hemoglobin / hematocrit needs to be improved
- Infuse plasma after 4 units of red cells, and cryoprecipitate after 8 units packed cells / 4 units plasma if needed
- Consider prothrombin complex concentrate or activated Factor VII in extreme cases