Saw my first head-injured dabigatran patient the other day.
He was completely fine, neurologically intact, and had had no LOC, but had epistaxis and lip lacerations which had clotted fine, and an abrasion on his nose (He also had a Colles #).
I elected not to CT his brain, and there were no ED short stay beds so to “observe” him I had to admit him under the surgeons as a post trauma obs patient.
I was left with these questions:
- how worried do we need to be about ICH in these patients on dabigatran?
- should we scan ‘em, and should we admit them, or am I being cautious out of ignorance?
- are there lab tests to quantify how anticoagulated they are?
- if they are bleeding, can we fix it? (unlike Bob the builder, it would appear that “no we can’t!”)
It seems my ignorance is shared – noone knows what to do about these patients yet, but we will see more, they will get head bleeds, and we probably can’t stop the bleeding, as no reversal agents have been shown to be fully effective yet (although some have theoretical reversal effects). Some answers, such as we have so far, are in the links below:
and a podcast from hqmeded (via emcrit.org):
Apparently some GPs here are being “allowed” (encouraged?) to put 10 patients on their books on it.
This is being called a “trial” but it ain’t no RCT!!!
We will see more of it, that’s for sure!