We recently had a 67-year-old man with atrial fibrillation who was
admitted from the EP lab after developing pericardial hemorrhage during
the procedure. He had been taking dabigatran and had received his last
dose seven hours prior to the procedure. He was undergoing an ablation
when a transseptal perforation occurred and hypotension ensued. He had
received 5000 units of heparin prior to the start of the procedure.
Pericardiocentesis was undertaken and 4500 cc of blood was withdrawn. He
was given two units of FFP & Protamine 100 mg with persistent bleeding.
He was then given FEIBA (activated prothrombin complex) 3159 units (26
units per kilogram over 15 minutes). One minute after initiating FEIBA
infusion slowing of the bleeding was observed. Bleeding stopped from
pericardiocentesis within minutes of administration of FEIBA. His PTT the
prior to the procedure was 53. ACT prior to administration of heparin was
233. The PTT decreased to 35 after protamine infusion but prior to the
FEIBA administration, and decreased further to 29 following FEIBA. ACT
decreased to 131 following FEIBA.
Our single experience would suggest that FEIBA was effective in reversing
the anticoagulant effect of dabigatran. I wonder if any others have had
an opportunity to use this treatment and what their experience has been?
Has anyone used other ways of reversing dabigatran and with what success?
admitted from the EP lab after developing pericardial hemorrhage during
the procedure. He had been taking dabigatran and had received his last
dose seven hours prior to the procedure. He was undergoing an ablation
when a transseptal perforation occurred and hypotension ensued. He had
received 5000 units of heparin prior to the start of the procedure.
Pericardiocentesis was undertaken and 4500 cc of blood was withdrawn. He
was given two units of FFP & Protamine 100 mg with persistent bleeding.
He was then given FEIBA (activated prothrombin complex) 3159 units (26
units per kilogram over 15 minutes). One minute after initiating FEIBA
infusion slowing of the bleeding was observed. Bleeding stopped from
pericardiocentesis within minutes of administration of FEIBA. His PTT the
prior to the procedure was 53. ACT prior to administration of heparin was
233. The PTT decreased to 35 after protamine infusion but prior to the
FEIBA administration, and decreased further to 29 following FEIBA. ACT
decreased to 131 following FEIBA.
Our single experience would suggest that FEIBA was effective in reversing
the anticoagulant effect of dabigatran. I wonder if any others have had
an opportunity to use this treatment and what their experience has been?
Has anyone used other ways of reversing dabigatran and with what success?
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