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  • Dr. Paul Dhillon MB BCh CCFP

Idarucizuma-whatfor?

SHORT ANSWER MANAGEMENT QUIZ:

  1. List ONE reversal agent for reversing bleeding in a patient on Dabigatran.

  2. List THREE medications / management steps that can be used to stop bleeding in a patient on Warfarin.

(answers below)

Make it stop! Just make it stop!

Praxbind™ is way easier to remember the spelling for than Idarucizumab.

In cases of life-threatening, uncontrolled bleeding, or in patients who need emergent surgery, we can now reverse Dabigatran. Pretty quickly as well! 2.5g of Praxbind™ given twice for a total dose of 5g IV within 15 minutes. Now you know!

Conveniently, it was the same company that makes Pradaxa that came up with the antidote, at over $3000 dollars a pop.

DID YOU KNOW – WARFarin comes from the acronym from the Wisconsin Alumni Research Foundation and the ending indicates its link to coumARIN.

Reversing Warfarin can be done by:

1. Vitamin K and

2. Octaplex [Unactivated prothrombin complex concentrates (PCC)] or

3. Fresh Frozen Plasma

4. Dialysis

And don’t forget the simple stuff: STOP Warfarin/Pradaxa and direct pressure along with transfusion of blood products and fluids if required.

EXAM TIP - Using trade names vs generic. Either is acceptable on the exam according to the CFPC’s SAMPs Instructions to Candidate!

Reference List

http://secure.medicalletter.org/article-share?a=1482a&p=tml&title=Idarucizumab%20(Praxbind)%20-%20An%20Antidote%20for%20Dabigatran&cannotaccesstitle=1

http://emottawa.blogspot.ca/2016/05/you-can-reverse-that-reversal-of-noacs.html

https://www.uptodate.com/contents/management-of-warfarin-associated-bleeding-or-supratherapeutic-inr?source=machineLearning&search=warfarin%20reversal&selectedTitle=1~32&sectionRank=3&anchor=H20#H20

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