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Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Review

Efficacy of prothrombin complex concentrates for the emergency reversal of dabigatran-induced anticoagulation

Authors: Oliver Grottke, James Aisenberg, Richard Bernstein, Patrick Goldstein, Menno V. Huisman, Dara G. Jamieson, Jerrold H. Levy, Charles V. Pollack Jr, Alex C. Spyropoulos, Thorsten Steiner, Gregory J. del Zoppo, John Eikelboom

Published in: Critical Care | Issue 1/2016

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Abstract

Dabigatran is effective in decreasing the risk of ischaemic stroke in patients with atrial fibrillation. However, like all anticoagulants, it is associated with a risk of bleeding. In cases of trauma or emergency surgery, emergency reversal of dabigatran-induced anticoagulation may be required. A specific reversal agent for dabigatran, idarucizumab, has been approved by the US Food and Drug Administration. Alternative reversal agents are available, such as prothrombin complex concentrates (PCCs) and activated PCCs (aPCCs). In this review we evaluate the role of PCCs and aPCCs in the reversal of dabigatran anticoagulation and consider which tests are appropriate for monitoring coagulation in this setting. Pre-clinical studies, small clinical studies and case reports indicate that PCCs and aPCCs may be able to reverse dabigatran-induced anticoagulation in a dose-dependent manner. However, dosing based on coagulation parameters can be difficult because available assays may not provide adequate sensitivity and specificity for measuring anticoagulation induced by dabigatran or the countering effects of PCCs/aPCCs. In addition, PCCs or aPCCs can potentially provoke thromboembolic complications. Despite these limitations and the fact that PCCs and aPCCs are not yet licensed for dabigatran reversal, their use appears to be warranted in patients with life-threatening haemorrhage if idarucizumab is not available.
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Metadata
Title
Efficacy of prothrombin complex concentrates for the emergency reversal of dabigatran-induced anticoagulation
Authors
Oliver Grottke
James Aisenberg
Richard Bernstein
Patrick Goldstein
Menno V. Huisman
Dara G. Jamieson
Jerrold H. Levy
Charles V. Pollack Jr
Alex C. Spyropoulos
Thorsten Steiner
Gregory J. del Zoppo
John Eikelboom
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1275-8

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