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September 20, 2012American Journal of Health-System Pharmacy

Reversal of dabigatran-induced bleeding with a prothrombin complex concentrate and fresh frozen plasma

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Why the study?

Does administration of prothrombin complex concentrate and fresh frozen plasma reverse dabigatran-induced bleeding in a patient with hemorrhagic shock?

Population

n=1, 85-year-old man with hemorrhagic shock secondary to upper gastrointestinal bleeding induced by…

Design

Case_report

Authors

LDLisa E. DumkowTrinity HealthJVJohnathan VossJohn Peter Smith HospitalMPMichael PetersBrighton and Sussex Medical School

Discussion

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Implication

May stabilize bleeding parameters in dabigatran shock; hypothesis-generating for PCC/FFP, should not yet change practice.

Structured PICO

Does administration of prothrombin complex concentrate and fresh frozen plasma reverse dabigatran-induced bleeding in a patient with hemorrhagic shock?

P
Population
n=1, 85-year-old man with hemorrhagic shock secondary to upper gastrointestinal bleeding induced by dabigatran, presenting with acute liver failure, acute kidney injury, and anemia. Medical history included hypertension, heart failure, stage III chronic kidney disease, cerebrovascular accident, prostate cancer, gastritis, esophagitis, diverticulosis, and a bleeding gastrointestinal ulcer.
I
Intervention
16 units of fresh frozen plasma (FFP) and 2000 units of a three-factor prothrombin complex concentrate (PCC)
O
Outcome
Hemostasis (stabilization of hemoglobin concentration and cessation of overt bleeding)safety

PCC and FFP may stabilize hemoglobin and reduce overt bleeding in dabigatran-induced hemorrhagic shock, though clinical outcomes may still be poor in patients with multiorgan failure.

Limitations

  • Confirmation of reversal was not possible due to the effect of concomitant liver failure on INR and aPTT

Cite This Study

Dumkow et al. (2012) studied this question.

synapsesocial.com/papers/6a70e76e660549caf2c58bb5https://doi.org/10.2146/ajhp120055
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