Dabigatran-associated subdural hemorrhage: using thromboelastography (TEG®) to guide decision-making

• DOI: 10.1007/s11239-013-0933-9
• Publication Date: 2013-05-10T08:33:51Z
• Authors: Ron Neyens; Nicole Bohm; Madelyne Cearley; Charles Andrews; Julio Chalela
• Keywords: Thromboelastography; Prothrombin complex concentrate

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.