This video is part of a larger CE/CME Certified program entitled: Impacting Emergency Department Bleeds: The Change is Here and Now. You can receive free CME credit, view this video, and download slides from the presentation at MedEdOnTheGo.com.
Hello and welcome to another episode of m craig international on the go i’m pleased to be joined by dr. gregory furman break i would like you to discuss if you would the bigot rant and the use of dabigatran as an anticoagulant is certainly present and it’s something in emergency physicians need to know about thanks brian so with respect to dabigatran which is
More widely known as pradaxa is a direct thrombin inhibitor our factor 2 inhibitor which makes it a bit unique among the noack class of agents and because of that it has a unique reversal agent but bear in mind treatment of a dabigatran associated hemorrhage starts with standard practice of resuscitation so iv fluids packed cells as necessary and the adherence
To what we would normally do in a patient that has an acute hemorrhage however if there is a recent administration of a factor 2 factor 2 inhibitor which is at the bigger tran you also have available an agent called i dare you susan mab that’s a mouthful but it’s called practice of mine and it is recently been studied as an available agent to actually bind up the
Bigotry and take it out of the system such that there’s no more active anticoagulation on board another unique feature of dabigatran is that it’s the only doe act that can be dialyzed so if there is a major hemorrhage situation and active dabigatran on board and you do not have the availability of the reversal agent dialysis is an option importantly vitamin k ffp
And pcs have real no no real role in the management of a dabigatran associated bleeding in terms of how you measure whether or not somebody’s actually ana coagulated with the bigoted ran there’s no really the bigotry and level to measure you can do in a karen clotting time but otherwise known as an ect or more widely available it’s an active partial thromboplastin
Time or 1/8 ptt which most labs that and in us hospitals will have available to them and then finally i dare you susan mab which is an fa b fragment which is an antibody that adhere – i davis isn’t map as fda-approved therapy five milligrams iv one-time dose will basically take down the level of idealism in the system to a very negative negative double level here
It depicts the molecule it’s an fa beat fragment as i just talked about the big train has a 350 times more affinity for the bigger tran than the bigot ran that’s four thrombin and so that’s why acts so quickly and so effectively and in terms of the levels that you see in the serum after it i dare systemic administration is depicted here which is the reverse ad
Trial and the new million journal in 2017 which basically shows shows you that once given i darius ism have been a patient that is therapy therapeutically anticoagulated with the bigoted ran the levels of activity of the bigoted ran almost go to zero within the first minutes of therapy in a very effective way to take the bigoted ran out of the system so represents
A strategic advantage in the treatment of hemorrhaging patient who happens to be on pradaxa greg thank you very much that’s a that’s a very important information and in particularly gives very specific information as to how to reverse the bigotry thank you very much for watching and craig international on-the-go
Transcribed from video
Bleeds with Dabigatran Managed in the ED or ICU By MedEdOTG