I just had pharmacy come over and ask me if I knew anything that could help with an overdose of Pradaxa, since physicians are asking them. Has anyone had this question posed to them? What are your thoughts on this?

TIA, Mari

I don't know what Pradaxa is (sorry!) BUT I would have thought that somewhere in the package insert there should be something that says what needs to be done to neutralise it; otherwise the manufacturers should know

There is another thread on this site that discusses Pradaxa overdose. I don't remember all the specifics, but I am relatively sure that it said there is no reversal agent for this drug.

From mims.com:

There is no antidote to dabigatran etexilate (Paradaxa) or dabigatran. Doses of dabigatran etexilate beyond those recommended may expose the patient to increased risk of bleeding. In the event of hemorrhagic complications, treatment must be discontinued, and the source of bleeding investigated. Since dabigatran is excreted predominantly by the renal route, adequate diuresis must be maintained. The initiation of appropriate treatment eg, surgical hemostasis or the transfusion of fresh frozen plasma should be considered.

Even though the package insert for Paradaxa that the transfusion of FFP should be considered, we had one patient with a GI bleed and taking Paradaxa that FFP did not reverse the PT/INR nor help stop the bleeding. Just had to wait it out with supportive therapies--fluids and Packed cells along with FFP.

I think this drug is to be monitored with thrombin time but I suppose since it works at the bottom of the coag cascade the PT and APTT would be abnormal also as Bill's post points out. They should not be able to market a blood thinner with no antidote. Plavix is bad enough.

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Attached (hopefully) is a nice guideline for dealing with Pradaxa and bleeding.

Thanks, Mabel!

We had a call from one of our invasive cardiologists about Pradaxa reversal about a month ago. We happened to have a Siemens Technical Service Rep on site working with new coagulation instruments for us. His recommendation for monitoring was an Ecarin clotting time (http://en.wikipedia.org/wiki/Ecarin_clotting_time), a non-FDA approved, research-only test performed at a handful of laboratories around the US. Mabel, thank you for the information regarding Pradaxa. What was the source(s) of your guidelines?