Management of severe dabigatran-related hemorrhage: case report, considerations for management, and recommendations.

Dabigatran is a direct thrombin inhibitor recently approved in the United States and Canada for the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation. Although dabigatran is administered as a fixed dose, does not interact with foods, and has fewer drug interactions than warfarin, the risk of hemorrhagic complications is similar for these two drugs. There is no specific reversal agent for dabigatran, and reversal of coagulopathy in the event of severe hemorrhage can be challenging. With growing use of dabigatran for long-term anticoagulation, it is important that acute care providers have a standardized and evidence-based approach to treating patients with severe hemorrhage secondary to dabigatran. We report a case of severe gastrointestinal hemorrhage related to dabigatran and discuss the management of severe hemorrhage in this context.