Dabigatran-associated subdural hemorrhage: using thromboelastography (TEG®) to guide decision-making
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Novel oral anticoagulants present challenges and uncertainties in the management of hemorrhagic emergencies. An 84-year-old man taking dabigatran presented with a subdural hematoma requiring neurosurgical intervention. Routine coagulation assays were prolonged at admission and following administration of Factor VIII Inhibitor Bypassing Activity (FEIBA). Thromboelastography (TEG®) was utilized to assess clot dynamics prior to placement of a subdural drain, which was safely inserted despite a prolonged thrombin time (TT). Exclusive reliance on the TT may delay necessary interventions. TEG® may be a valuable tool to investigate hemostasis in patients on dabigatran requiring emergent procedures.
KeywordsDabigatran Intracranial hemorrhage Thromboelastography Prothrombin complex concentrates FEIBA
Conflict of interest
The authors declare that they have no conflict of interest.