Recombinant factor VIIa (rFVIIa) and hemodialysis to manage massive dabigatran-associated postcardiac surgery bleeding

摘要

Dabigatran is a new oral direct thrombin inhibitor approved to prevent stroke in atrial fibrillation. It has no antidote, and management of severe bleeding is uncertain. A participant in RE-LY (randomized trial that compared dabigatran with warfarin1) unintentionally underwent cardiac surgery with therapeutic dabigatran levels, resulting in massive postoperative bleeding. We report the timeline of bleeding, hemostatic parameters, and dabigatran plasma levels (by HPLC) in response to emergency management with rFVIIa and hemodialysis.