🩸 Dabigatran Reversal in Mild Traumatic Brain Injury [Neurosurgery Wiki]

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====== 🩸 Dabigatran Reversal in Mild Traumatic Brain Injury ======

===== Latest =====
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===== 🧠 Context =====
Patients on **[[dabigatran]] (Pradaxa)** who suffer a **[[mild traumatic brain injury]] (GCS 13–15)** are at increased [[risk]] of [[delayed]] [[intracranial]] [[bleeding]]. Prompt assessment and potential [[dabigatran reversal]] are essential.

===== 🔍 Initial Evaluation =====
  * Immediate non-contrast head **CT scan**
  * Assess:
    * **[[GCS]] [[score]]**
    * [[Neurological deficit]]s
    * Timing and [[severity]] of [[trauma]]
    * Last **dabigatran** intake (within last 12–24h, most relevant)
  * [[Renal function]] ([[creatinine clearance]]) to estimate [[drug]] [[clearance]]

===== 💉 Reversal Protocol =====

=== ✅ If **CT shows intracranial hemorrhage** or clinical signs of bleeding: ===
  * Administer **[[idarucizumab]] (Praxbind) 5 g IV**, in two consecutive 2.5 g [[bolus]] [[infusion]]s (within 15 minutes)
  * Monitor for signs of rebound [[anticoagulation]]

=== ⏳ If **CT is normal**, but high bleeding risk: ===
  * Consider **holding dabigatran**
  * Observe clinically for 12–24h
  * Repeat **head CT** in 6–12h if:
    * Age >75
    * [[High-energy trauma]]
    * [[Antiplatelet]] co-medication
    * Comorbidities ([[renal failure]], [[dementia]])

=== ❌ If **low-risk + normal CT**: ===
  * [[Outpatient]] [[observation]] may be considered after:
    * Neurology/neurosurgery consult
    * Patient/family [[informed consent]]
    * Structured [[discharge]] [[instruction]]s

===== 📋 Documentation Checklist =====
  * Exact [[time]] and [[dose]] of last dabigatran intake
  * [[Neurological examination]] + [[GCS]]
  * [[CT]] findings
  * [[Renal function]]
  * [[Reversal]][[ indication]] and timing
  * Plan for repeat imaging (yes/no, when)
  * Disposition (admit vs discharge)

===== ✅ Best Practice =====
  * Use **[[Idarucizumab]]** only in active or high-risk bleeding
  * Ensure protocol is aligned with the [[emergency department]] and the [[ICU]]
  * Educate [[staff]] on location and indications for [[reversal]] [[agent]]s

===== 🔗 See Also =====

  * [[Anticoagulation reversal]]