title: Dabigatran-associated subdural hemorrhage: using thromboelastography (TEG(®)) to guide decision-making.
abstract: Novel oral anticoagulants present challenges and uncertainties in the management of hemorrhagic emergencies. An 84-year-old man taking dabigatran presented with a subdural hematoma requiring neurosurgical intervention. Routine coagulation assays were prolonged at admission and following administration of Factor VIII Inhibitor Bypassing Activity (FEIBA). Thromboelastography (TEG(®)) was utilized to assess clot dynamics prior to placement of a subdural drain, which was safely inserted despite a prolonged thrombin time (TT). Exclusive reliance on the TT may delay necessary interventions. TEG(®) may be a valuable tool to investigate hemostasis in patients on dabigatran requiring emergent procedures.
authors.affiliation: Department of Pharmacy, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Neyens
authors.forename: Nicole
authors.initials: N
authors.lastname: Bohm
authors.forename: Madelyne
authors.initials: M
authors.lastname: Cearley
authors.forename: Charles
authors.initials: C
authors.lastname: Andrews
authors.forename: Julio
authors.initials: J
authors.lastname: Chalela
mesh_terms: D000369:Aged, 80 and over; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects*; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects*; D000069604:Dabigatran; D003657:Decision Making; D006408:Hematoma, Subdural / Q000097:blood* / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D013916:Thrombelastography; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000991:Antithrombins; D001562:Benzimidazoles; D015091:beta-Alanine; D000069604:Dabigatran