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

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 protocol^a

(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