However, a randomized, placebo-controlled study of PCC showed no effects on the anticoagulation effects of dabigatran. In dabigatran-related hemorrhagic emergencies, prothrombin complex concentrate (PCC) has been used in an attempt to reduce bleeding. Emergent hemodialysis can remove circulating dabigatran, but is not a rapidly available option in many cases. ĭabigatran is a direct thrombin inhibitor, so it cannot be reversed with vitamin K or fresh frozen plasma. Patients taking dabigatran are at risk for serious hemorrhagic complications, and until recently, there was no available reversal agent. TSOACs have several benefits over the older vitamin K antagonist, warfarin: there are reportedly fewer serious bleeding complications, patients do not require frequent monitoring of coagulation, and there are no dietary restrictions.ĭabigatran (Pradaxa®) is a drug created by Boehringer Ingelheim Pharmaceuticals that was approved for use in the United States in 2010 for non-valvular atrial fibrillation, as well as for treatment and prevention of DVT and PEs. The prescription and use of target-specific oral anticoagulants (TSOACs) have sky-rocketed in the last five years as new agents have flooded the market. It proved effective in lab trials, but is it ready for prime time in the ED? On October 16th, the FDA approved the use of idarucizumab (Praxbind®), a monoclonal antibody developed by Boehringer Ingelheim Pharmaceuticals for the reversal of dabigatran.
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