Although the NOACs are associated with fewer serious bleeding complications than warfarin, life-threatening bleeding can still occur. This made emergency physicians and others who anticipate worst case scenarios somewhat nervous. However, a major concern is that unlike warfarin, which can be reversed with Prothrombin Complex Concentrates (PCC) or fresh frozen plasma and vitamin K, dabigatran and the other NOACs lacked a dedicated reversal agent. Their pharmacokinetics are simpler, they don’t have the pesky food and drug interactions that plague warfarin, they don’t require monitoring and frequent dose adjustments, and importantly, they carry a lower risk of major bleeding complications. Dabigatran and other NOACs have several advantages over warfarin. Dabigatran is a direct thrombin inhibitor used for stroke prevention in patients with atrial fibrillation and for treatment and secondary prevention of venous thromboembolism.

The new oral anticoagulants (NOACs) are skyrocketing in popularity, displacing warfarin as first-line anticoagulants for many patients.

You know you need to reverse her anticoagulation, but how? After paging your neurosurgeon on call, you consider your options for reversal of anticoagulation. The CT shows an intraparenchymal hemorrhage.

The patient is somnolent, and after quickly securing her airway, you send her for a stat head CT. Her past medical history is significant for hypertension and atrial fibrillation, for which she takes atenolol and dabigatran (Pradaxa). Here’s what you need to know about this target-specific reversal agent for Dabigatran.Ī 67-year-old woman is brought in by EMS after she developed a severe headache at home with associated vomiting and altered mental status. New oral anticoagulants (NOACs) are skyrocketing in popularity.

Pradaxa reversal