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

Grottke, Oliver; Aisenberg, James; Bernstein, Richard; Goldstein, Patrick; Huisman, Menno V.; Jamieson, Dara G.; Levy, Jerrold H.; Pollack, Charles V.; Spyropoulos, Alex C.; Steiner, Thorsten; del Zoppo, Gregory J.; Eikelboom, John

doi:10.1186/s13054-016-1275-8

Critical Care

Table 5 Case studies investigating the use of PCCs and aPCCs to reverse dabigatran-induced anticoagulation

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

Study	Patient	Dabigatran dose	Case presentation	Treatment	Results
Dumkow et al., 2012 [23]	85-year-old male with hypertension	150 mg twice daily	Acute liver failure, acute kidney injury and anaemia, with upper GI bleeding from an ulcer	2000 U PCC	Haemoglobin concentration stabilised and bleeding ceased
Dumkow et al., 2012 [23]	85-year-old male with hypertension	150 mg twice daily		16 U FFP	Haemoglobin concentration stabilised and bleeding ceased
Weitz et al., 2012 [32]	78-year-old male with AF, hypertension and a history of ischaemic stroke	150 mg twice daily	Haematemesis and melena	8 U RBCs	Blood loss was promptly reduced and the patient was stabilised
			Hb 5.9 g/dl	12 U platelets
			Creatinine clearance 26 ml/min	8 U cryoprecipitate	Patient discharged on reduced dabigatran dose (75 mg twice daily)
			aPTT 83 s	40 U/kg PCC
			TT > 150 s	40 U/kg PCC
Javedani et al., 2013 [46]	54-year-old male with AF and hypertension	150 mg twice daily	Acute ischaemic stroke	4520 mg PCC	Coagulation parameters measured post PCC administration:
			Creatinine 1.0 mg/dl	1 mg rFVIIa	Coagulation parameters measured post PCC administration:
			aPTT 30.3 s		aPTT 28.5 s
			INR 1.25		INR 0.82
			INR 1.25		Patient was discharged after 7 days on aspirin and warfarin
Schulman et al., 2014 [61]	84-year-old male with AF	110 mg (unknown frequency)	Subdural haematoma following a fall	50 U/kg aPCC	No immediate change in coagulation profile
			TT 127 s		Thrombin time normalised after 3 days
			aPTT 46 s		Bleeding resolved
			INR 1.2		Patient discharged on day 4 with complete resolution of weakness
	81-year-old female with AF and hypertension	110 mg (unknown frequency)	CT scan identified haemorrhage in left basal ganglia	42 U/kg aPCC	Repeat imaging after 3 days showed slight increase in haematoma size
			aPTT 48 s		Speech normalised on day of admission
			TT > 150 s		Motor function required 2 months rehabilitation
			TT > 150 s		Normal mobility and strength but slight right-sided numbness after 13 weeks
	85-year-old female with AF, hypertension, dyslipidaemia, chronic kidney disease and previous myocardial infarction	75 mg twice daily	Undergoing insertion of dual-chamber pacemaker	100 U/kg aPCC	Bleeding ceased but thrombin time remained immeasurable for 3 days
			aPTT 65 s
			Creatinine clearance 27 ml/min
	83-year-old female with AF	110 mg twice daily	Admitted to hospital with upper GI bleeding	50 U/kg aPCC	Clinical condition stabilised following administration of PCC
			Admitted to hospital with upper GI bleeding	3 U RBCs
			Hb 99 g/l
			Creatinine clearance 24 ml/min
Masotti et al., 2015 [62]	93-year-old female with AF	110 mg twice daily	Major bleeding from GI tract	25 U/kg PCC at 0 and 6 h	Bleeding ceased, but no improvement in coagulation parameters was observed after either PCC dose
			aPTT 89 s	25 U/kg PCC at 0 and 6 h
			PT 21 %	Tranexamic acid
					No more re-bleeding occurred
					Coagulation parameters normalised after 6 days (aPTT 28 s, PT 90 %) and patient was discharged

AF atrial fibrillation, aPCC activated prothrombin complex concentrate, aPTT activated partial prothrombin time, FFP fresh frozen plasma, GI gastrointestinal, Hb haemoglobin, INR international normalised ratio, PCC prothrombin complex concentrate, PT prothrombin time, RBC red blood cell, rFVIIa recombinant activated factor VII, TT thrombin time

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ISSN: 1364-8535

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