Canterbury DHB

Context

Bleeding following New Oral Anticoagulants (e.g. dabigatran)

The new oral anticoagulant currently in use in NZ is dabigatran (a direct factor lla, or thrombin, inhibitor). This agent reaches maximum effect 1.5 to 3 hours after an oral dose. Dabigatran half-life is 12-14 hours. The major adverse effect of all anticoagulant medications is bleeding. A specific antidote to reverse dabigatran is available from the CDHB Pharmacy Department (See Idarucizumab on Hospital HealthPathways - Bleeding After Dabigatran). The anticoagulant effect will not be reversed by administration of vitamin K or plasma infusion. There are two types of responses to bleeding events in this setting:

Standard response to bleeding:

  1. Withhold or discontinue anticoagulant drug
  2. Mechanical compression at bleed site
  3. Interventional techniques such as embolisation or local injection of vasoconstrictors
  4. Fluid replacement, haemodynamic support, including blood components

New anticoagulant reversal, if standard response fails to control bleeding:

Anticoagulant-associated bleeding event

Crowther et al. Bleeding risk and the management of bleeding complications in patients undergoing anticoagulant therapy: focus on new anticoagulant agents. Blood 2008;111(10):4871-4879

About this Canterbury DHB document (34073):

Document Owner:

Mark Smith (see Who's Who)

Issue Date:

August 2016

Next Review:

August 2018

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 34073