UMEM Educational Pearls

Category: Toxicology

Title: aPCC for rivaroxaban and dabigatran

Keywords: rivaroxaban, dabigatran (PubMed Search)

Posted: 11/21/2013 by Fermin Barrueto, MD (Updated: 9/22/2019)
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Reversal of the new anticoagulants rivaroxaban (Xarelto) and dabigatran (Pradaxa) has been challenging particularly in the ED setting with no definitive reversal agent. Intracerebral hemorrhage or critical GI bleed management becomes challenging and worsens mortality.

There is growing literature that states activated prothrombin complex concentrate or non-activated PCC may reverse these new anticoagulants. A volunteer study (1) showed its efficacy and concensus workgroups are now recommending aPCC as first line therapy(2).  The search goes on for a reliable reversal agent for these new anticoagulants which were suppose to solve more problems instead of create new ones.

References

  1) Eerenberg ES, Kamphuisen PW, Sijpkens MK, Meijers JC, Buller HR, Levi M.  Reversal of rivaroxaban and dabigatran by prothrombin complex concentrate: a  randomized, placebo-controlled, crossover study in healthy subjects. Circulation. 2011 Oct 4;124(14):1573-9.     2) Pernod G, Albaladejo P, Godier A, Samama CM, Susen S, Gruel Y, Blais N,  Fontana P, Cohen A, Llau JV, Rosencher N, Schved JF, de Maistre E, Samama MM,  Mismetti P, Sié P; Working Group on Perioperative Haemostasis. Management of  major bleeding complications and emergency surgery in patients on long-term  treatment with direct oral anticoagulants, thrombin or factor-Xa inhibitors:  proposals of the working group on perioperative haemostasis (GIHP) - March 2013.  Arch Cardiovasc Dis. 2013 Jun-Jul;106(6-7):382-93.