Pradaxa (dabigatran etexilate mesylate) is a blood-thinning medication used to prevent stroke and to reduce the risk of blockage of arteries in patients with nonvalvular atrial fibrillation (irregular heartbeat). It directly inhibits thrombin, the final step in the blood clotting pathway. The half-life (time it takes to eliminate half the amount in the body) of dabigatran is about 8 hours after administration of a single dose, but can range from 12 to 14 hours after multiple doses. In older patients, the average half-life is 13 hours. Pradaxa can cause serious bleeding that is significant and sometimes fatal. The risk for bleeding increases when taken with medications such as Plavix or aspirin. Signs and symptoms of blood loss are a drop in blood pressure and a drop in hemoglobin and hematocrit. Pradaxa should be discontinued 1 to 5 days prior to surgery due to increased risk of bleeding. Longer discontinuation periods may be needed for major surgeries such as spinal, abdominal, or heart surgeries.

Managing bleeding events associated with Pradaxa

Pradaxa now has an antidote (reversal agent), an agent that can reverse its effect. In addition to using the antidote, methods for managing bleeding in patients receiving Pradaxa include discontinuing the drug, treating the tissue that is bleeding, administering blood replacement products, use of activated charcoal, antifibrinolytic drugs, administering prothrombin complex concentrates (PCC), and eliminating the drug through dialysis.

Next: Charcoal, Dialysis, Antifibrinolytic Agents