Use of prothrombin complex concentrates for urgent reversal of dabigatran in the Emergency Department

New oral anticoagulants (NOACs) are being implemented for use in daily clinical practice, anticoagulants that should theoretically replace the well-known vitamin K antagonists in the near future. Based on their inhibitory properties, NOACs can be classified into two main groups: direct thrombin inhibitors with dabigatran as the only available compound 1 and factor Xa inhibitors, namely rivaroxaban and apixaban. 2 Dabigatran has a low oral bioavailability, a low protein binding (35%) and its half-life reaches 14-17 hours in patients with normal renal function, but is longer in patients with impaired renal function and advanced age. A number of advantages of dabigatran over vitamin K antagonists have been reported, such as the lack of need for periodic blood testing or for any dose adjustment. Specific blood tests, such as the diluted thrombin time (Haemoclot), are being developed but are not yet universally available at any given moment. However, the main limitation in the use of dabigatran is that there is currently no available antidote for this drug. A small number of options have been proposed in the event of an overdose: activated charcoal whenever possible, dialysis and/or the use of prohemostatic agents such as prothrombin complex concentrates (PCC), activated prothrombin complex concentrates (FEIBA), and recombinant activated factor VII (rFVIIa). e describe our experience in the emergency department (ED) with the urgent reversal of dabigatran anticoagulation using PCC. We collected data from all patients administered dabigatran who were treated at the ED between July 2011 and June 2012. From among these cases, any patient who developed a hemorrhagic complication was included. Relevant data from the electronic clinical history and prescriptions were collected. Additionally, we followed up patients for six months and we reviewed thrombotic complications. A descriptive data analysis was performed and we compared the blood parameters at the start of the treatment with dabigatran, at the moment of the hemorrhagic episode, and before and after the administration of PCC. The study was approved by the hospital Ethics Committee.