Impact of Pradaxa in the lab and Blood Bank

[Mabel Adams]

Can any of our Canadian or European colleagues share their experience with this anticoagulant that was just approved in the US to take the place of warfarin? Do they reverse the effects with plasma? How does it look on coag tests? Anything we need to know about it? I see that Xarelto and apixaban are also heading our way someday in the possibly near future.

[rrcc1974]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2000654/

search for "reversal"

[rrcc1974]

http://www.medicines.org.au/files/bypprada.pdf

search "prothrombin"

[Mabel Adams]

Thanks for the links. No antidote, not reversible, doesn't completely clear for 7 days, Protime not sensitive enough but thrombin time is. Doesn't require monitoring like coumadin. Effective within a couple of hours of first dose. Bleeding risk increases with dose. Sounds like a Blood Banker's nightmare. Probably it will be expensive so that may help.

I can imagine someone coming in via the ED needing to go to surgery; they do usual coags (no TT) which are ok, then take him to surgery and he won't stop bleeding. Has anyone seen things like this where this has been in use awhile or am I doing a bit of Chicken Little here?

[carolyn swickard]

My mother was just put on this drug - she never tolerated coumidin very well. Has anyone worked out a reversal scheme for this yet? any thoughts?

[clmergen]

Is that the one that recommends the use of NovoSeven to reverse (for about 6 hours). I know there is a new drug out there that recommends this. I would go online and print the package insert. Reversal information should be on that.

[Bill]

Mabel has it correct as stated in the package insert. No reversal known.