Bleeding may occur at any site during therapy with Pradaxa. An unexplained fall in hemoglobin and/or hematocrit or blood pressure should lead to a search for a bleeding site.1
In the case of life-threatening or uncontrolled bleeding Praxbind should be used.2,3 Other bleeds can be managed similarly to warfarin bleeds (excluding vitamin K application).1,4,5
Emergency or urgent surgery
In case of emergency surgery or urgent procedures when rapid reversal of the anticoagulation effect is required, a specific reversal agent, Praxbind (idarucizumab) to Pradaxa is available.2
After administration of Praxbind, other antithrombotic therapy (e.g. low-molecular weight heparin) can be started at any time, if the patient is clinically stable and adequate hemostasis has been achieved.2
Pradaxa treatment can be re-initiated 24 hours after administration of Praxbind if the patient is clinically stable and adequate hemostasis has been achieved.1
To download the Praxbind User Guide click here.
Clinical management of bleeding emergencies
Measures include fluid replacement (colloids if needed), packed red blood cells if needed, fresh frozen plasma (as plasma expander), platelet
- Pradaxa Summary of Product Characteristics 2016. Boehringer Ingelheim.
- Praxbind Summary of Product Characteristics 2016. Boehringer Ingelheim.
- Pollack CV Jr et al. N Engl J Med 2015;373(6):511–520.
- van Ryn J et al. Thromb Haemost 2010;103:1116–1127.
- Heidbuchel H et al. Europace 2013;15:625–651.
- Warfarin Summary of Product Characteristics 2014. Amdipharm Mercury Company Limited.
- Vang ML et al. Acta Anaesthesiol 2011;55(5):507–516.
- Craig T et al. J Am Coll Cardiol 2014;64(21):2246–2280.
- Spahn DR et al. Crit Care 2007;11(1):R17.
- Majeed A et al. Circulation 2013;128(21):2325–2332.