Editing Anticoagulation (section)

== Dabigatran (Pradaxa) ==

* Taken from Austin guideline published 25/2/16
* Oral direct thrombin inhibitor
* Elimination half-life 12-17 hours. Eliminated at kidneys.
* Monitoring: PT and APTT are unreliable, but normal APTT suggests unlikely high levels of dabigatran. 
** Best available monitoring is thrombin clotting time (TCT) - if normal, excludes presence of dabigatran
** HEMOCLOT is a dilute thrombin clotting time assay but doesn't correlate well with risk of bleeding
* Reversal: idarucizumab - monoclonal Ab, binds to dabigatran. Achieves rapid and complete reversal. Generally safe - 5% risk of thrombosis.
** Approval required via either anaesthetist in charge or haem consultant on call
** Used in life-threatening bleeding or for urgent surgery
** Dose is 5g IV either bolus or infusion - see guideline for full order
** Perform dabigatran levels and TCT both prior to, post, and 4 hours post administration
**
* Dialysis may enhance clearance
* Elective surgery:

* Recommence 48-72 hours post high risk surgery