Emergency reversal of dabigatran for emergency surgery.
An 80-year-old woman had the anticoagulant effect of dabigatran etexilate reversed using factor eight inhibitor bypassing activity (FEIBA) in order to facilitate emergency surgery for an incarcerated femoral hernia. She had atrial fibrillation was taking the anticoagulant for stroke prevention. That afternoon her international normalised ratio (INR) was 1.3 and activated partial thromboplastin time ratio (APPTr) was 2.17, having taken dabigatran that morning. 3000 units of FEIBA and 10 mg of vitamin K were administered and she was taken to theatre for emergency surgery. Surgery was successful, total blood loss was less than 100 mL and there were no complications. The following morning she had an INR of 1.1 and APPTr of 1.49. She made an uneventful postoperative recovery and was discharged home. There is a limited evidence base guiding practice in the clinical scenario described. The only controlled studies available are animal experiments.
Department of General Surgery, Royal Berkshire NHS Hospital, Reading, Berkshire, UK.
Thomas
T
Puttick
Department of General Surgery, Royal Berkshire NHS Hospital, Reading, Berkshire, UK.
Rahul
R
Bahl
Department of General Surgery, Royal Berkshire NHS Hospital, Reading, Berkshire, UK.
Hussein
H
Mohamedbhai
D000369:Aged, 80 and over; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001779:Blood Coagulation Factors / Q000008:administration & dosage*; D000069604:Dabigatran / Q000008:administration & dosage / Q000009:adverse effects*; D004635:Emergency Medicine; D005260:Female; D006550:Hernia, Femoral / Q000601:surgery*; D006801:Humans; D019934:International Normalized Ratio; D010314:Partial Thromboplastin Time; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D016896:Treatment Outcome
D000991:Antithrombins; D001779:Blood Coagulation Factors; C065655:anti-inhibitor coagulant complex; D000069604:Dabigatran