What does this research mean for the field?

4-factor prothrombin complex concentrate effectively reverses dabigatran-induced gastrointestinal bleeding in a patient who did not respond to other treatments. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To highlight the challenges and treatment options for dabigatran-induced major bleeding.

March 15, 2026Journal of the Association of Physicians of India

Dabigatran-induced Gastrointestinal Bleed Treated by 4-factor Prothrombin Complex Concentrate in a Tertiary Care Hospital in Sikkim

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Key result

4-factor PCC successfully halts refractory dabigatran-induced hemorrhage in a single patient.

Why the study?

When the specific reversal agent idarucizumab is unavailable, alternative reversal agents like PCCs may be needed for dabigatran-induced life-threatening bleeding despite dosing challenges and thromboembolic risks.

Does 4-factor Prothrombin Complex Concentrate (PCC) improve bleeding outcomes in a patient with dabigatran-induced gastrointestinal bleed?

Key Points

To highlight the challenges and treatment options for dabigatran-induced major bleeding.
Case report of a 65-year-old male with gastrointestinal bleeding due to dabigatran.
Monitoring of coagulation parameters including hemoglobin, prothrombin time (PT), and international normalized ratio (INR).
Treatment involved blood transfusions, vitamin K, fresh frozen plasma, and prothrombin complex concentrate.
Patient presented with severe anemia (Hb: 5.8 gm/dL) and bleeding despite initial treatments.
Significant improvement after administration of prothrombin complex concentrate was noted.
No further transfusion products were needed and the patient was discharged after 4 days.

Structured PICO

Does 4-factor Prothrombin Complex Concentrate (PCC) improve bleeding outcomes in a patient with dabigatran-induced gastrointestinal bleed?

Population

65-year-old male presenting with coagulopathy, anemia, and fresh bleeding per rectum (Hb: 5.8 gm/dL, PT 20.02 seconds, INR: 1.55) while on dabigatran for 1 month.

Intervention

4-factor Prothrombin Complex Concentrate (PCC) administered after failure of stopping dabigatran, vitamin K injection, 4 units of blood transfusion, and 8 units of fresh frozen plasma (FFP).

Outcome

Cessation of bleeding and need for additional transfusion productshard clinical

4-factor PCC may serve as an effective alternative for reversing dabigatran-induced life-threatening bleeding when the specific reversal agent idarucizumab is unavailable.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

4-factor PCC may be alternative to idarucizumab for dabigatran bleeding; hypothesis-generating case report that should not yet change practice.

Cite This Study

Dhakal et al. (2026) studied this question. Administration of 4-factor prothrombin complex concentrate led to significant improvement and cessation of bleeding in a 65-year-old male with dabigatran-induced hemorrhage.

synapsesocial.com/papers/69b64c9ab42794e3e660dc8b https://doi.org/10.59556/japi.74.1324

Topics

Anticoagulation in AF

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Implication

4-factor PCC may be alternative to idarucizumab for dabigatran bleeding; hypothesis-generating case report that should not yet change practice.

Dabigatran-induced Gastrointestinal Bleed Treated by 4-factor Prothrombin Complex Concentrate in a Tertiary Care Hospital in Sikkim

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Dabigatran-induced Gastrointestinal Bleed Treated by 4-factor Prothrombin Complex Concentrate in a Tertiary Care Hospital in Sikkim

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider