Dabigatran: patient management in specific clinical settings.

Kyrle, Paul Alexander; Binder, Konrad; Eichinger, Sabine; Függer, Reinhold; Gollackner, Bernd; Hiesmayr, J Michael; Huber, Kurt; Lang, Wielfried; Perger, Peter; Quehenberger, Peter; Roithinger, Franz X; Schmaldienst, Sabine; Weltermann, Ansgar; Domanovits, Hans

Dabigatran, a direct thrombin inhibitor, is licensed for the prevention of venous thromboembolism after knee and hip replacement, the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation and for the treatment of acute venous thromboembolism. As dabigatran has a favourable benefit-risk profile, it is being increasingly used. Dabigatran differs from vitamin K antagonists as regards its pharmacological characteristics and its impact on certain laboratory tests, and also in the lack of a direct antagonist that can reverse dabigatran-induced anticoagulation. In emergency settings such as acute bleeding, emergency surgery, acute coronary syndrome, thrombolysis for ischaemic stroke or overdosing, specific strategies are required. A working group of experts from various disciplines has developed strategies for the management of dabigatran-treated patients in emergency settings.