It has been shown to normalise prothrombin time in a trial of 12 healthy male subjects at a dose of 50 IU/kg (administered as a slow IV injection) (Eerenberg et al., 2011). For life-threatening bleeding or emergency surgery, consider the use of prothrombin complex concentrate (Prothrombinex®-VF) in consultation with haematology (risk of thrombotic complications).

Idarucizumab: Reversing the effects of Dabigatran (CEC Factsheet, August 2016).

aPTT >80 seconds or a dabigatran level >500 mg/mL.

Consider dialysis in patients treated with dabigatran who have life-threatening bleeding and:.

Give as 2 consecutive IV infusions of 2.5 g over 5–10 minutes each OR as 2 consecutive 2.5 g bolus injections Consider idarucizumab (Praxbind) - study dose: 5 g IV as a single dose (Pollack, 2015).Recombinant factor VIIa (NovoSeven® RT) is no longer recommended but other pro-haemostatic agents may be considered in consultation with haematology for life-threatening bleeding (significant risk of thrombotic complications).For ingestion within 2 hours: activated charcoal.Withhold further doses of anticoagulant.Send coagulation profile, including relevant levels (dabigatran level, aPTT, TT, prothrombin time and/or anti-Xa level).Organise urgent FBC, group and hold, creatinine.(2014) New oral anticoagulants: a practical guide on prescription, laboratory testing and peri-procedural / bleeding management, Internal Medicine Journal, vol. NOAC Guidelines: Management of NOAC associated bleeding (CEC, July 2017).

Most concerns regarding NOACs in the ED relate to reversal or commencement. NOACs currently registered for use in Australia include: dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis). Previously, warfarin was the only oral anticoagulant available in Australia however since the introduction of NOACs, this has increased the drug choices available for oral anticoagulation. Also known as “Non-Vitamin-K-antagonist Oral Anticoagulants” (NOACs) or “Direct Oral Anticoagulants” (DOACs).

Antidote for apixaban