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

Table 2 Recommendations and algorithms for the management of bleeding patients with 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 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

^aTransfusion of FFP/platelets/RBCs
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