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Table 2 Recommendations and algorithms for the management of bleeding patients with dabigatran-induced anticoagulation

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

Reference Mild bleeding Moderate-to-severe bleeding Life-threatening bleeding or intracranial haemorrhage
Weitz et al., 2012 [32] Discontinue treatment until bleeding resolves Sequential treatment: aPCC (50 IU/kg)
(1) PCC (40 IU/kg) If unavailable, give PCC (40 IU/kg) or rFVIIa (90 μg/kg)
(2) aPCC (50 IU/kg)
(3) rFVIIa (90 μg/kg)
(4) Haemodialysis for 6–8 h or charcoal filtration
Faraoni et al., 2015 [29] No recommendation given No recommendation given (1) Monitor blood loss and perform coagulation assays
(2) Standard resuscitation with fluid therapy, tranexamic acid (1 g), RBCs and massive transfusion protocola
(3) Four-factor PCC (25–50 IU/kg), aPCC (FEIBA; 30–50 IU/kg)
EHRA guidelines [30] Maintain diuresis Same recommendation as for mild bleeding PCC 50 U/kg (additional 25 U/kg if clinically needed)aPCC 50 U/kg (maximum 200 U/kg/day)rFVIIa (90 μg/kg)Idarucizumab 5 g intravenously
Local haemostatic measures
Fluid replacement  
RBC substitution if necessary
Platelet substitution if necessary  
FFP as plasma expander (not as reversal agent)  
Consider tranexamic acid or desmopressin
Consider dialysis
ESA guidelines [28] No recommendation given No recommendation given PCC, aPCC or rFVIIa may be used as non-specific antagonists
  1. aTransfusion of FFP/platelets/RBCs
  2. aPCC activated prothrombin complex concentrate, EHRA European Heart Rhythm Association, ESA European Society of Anaesthesiology, FFP fresh frozen plasma, PCC prothrombin complex concentrate, RBC red blood cell, rFVIIa, recombinant activated factor VII, FEIBA, factor eight inhibitor bypassing activity