Recombinant factor VII (NovoSeven) won’t be effective. One option is fresh frozen plasma (FFP), which takes 20 minutes to defrost, has be matched to the patient’s blood type, is hard to give in large volumes quickly, and isn’t at all specific for dealing with DOACs of any type. Until recently, trying to reverse DOACs was hard, if not impossible. What about the DOAC issue? New Option for Dabigatranįortunately, the patient is on dabigatran (Pradaxa). You start the IVs and give lactated Ringer’s. The nearest hospital is 45 minutes away, and it is starting to snow. You have a general surgeon on call, and transfer to another hospital is really out of the question. To make matters worse, his focused assessment with sonography in trauma (FAST) exam reveals free abdominal fluid. His medication list includes an angiotensin-converting-enzyme inhibitor and spironolactone for his blood pressure, metformin and a sodium-glucose cotransporter 2 drug for his diabetes, and a direct oral anticoagulant (DOAC). His heart rate is 115, and his blood pressure is 115/70. His heart rate is irregular, consistent with atrial fibrillation, which is confirmed on a monitor. There is no chest wall crepitus, and his lungs are clear. His head and neck exam are normal, except for some facial abrasions. He has a history of diabetes (type 2), coronary artery disease, hypertension, and atrial fibrillation. He is developing some progressive abdominal tenderness, and a lap belt sign is starting to develop.

He says that his lower chest hurts when he takes a deep breath.

He is awake but diaphoretic, and his breathing is rapid but unlabored.

New Developments in Direct Oral Anticoagulant Safety and IndicationsĮxplore This Issue ACEP Now: Vol 38 – No 01 – January 2019.

New-Drug Details: Reversing Anticoagulant Dabigatran with Idarucizumab.

Pradaxa reversal