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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
16 U FFP
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
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
aPTT 30.3 s  aPTT 28.5 s
INR 1.25  INR 0.82
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
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
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
PT 21 % Tranexamic acid
No more re-bleeding occurred
Coagulation parameters normalised after 6 days (aPTT 28 s, PT 90 %) and patient was discharged
  1. 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