GI Bleeding on Dabigatran — EECC MCQ

Correct answer: D — Withhold dabigatran, supportive care (IV fluids, PPI, transfusion if needed), urgent endoscopy; specific reversal with idarucizumab (5 g IV) is reserved for life-threatening or uncontrollable bleeding — for moderate stable GI bleeding, withholding the drug and supportive care is usually sufficient given dabigatran's short half-life (12-17h)

DOAC-related bleeding management is severity-stratified per ESC 2024 AF Guidelines: (1) Minor bleeding: withhold 1-2 DOAC doses, local measures; (2) Moderate non-life-threatening bleeding (this case): withhold DOAC (dabigatran has a relatively short half-life ~12-17h, so drug levels will decline rapidly), supportive care (IV fluids, blood products if needed, PPI), urgent endoscopy for source identification and treatment; (3) Life-threatening/critical bleeding (haemodynamic instability, >2 unit transfusion, intracranial, pericardial): specific reversal — idarucizumab 5 g IV for dabigatran (immediate and complete reversal). Activated charcoal may be considered if the last DOAC dose was within 2 hours (absorbs drug in GI tract). Haemodialysis can also remove dabigatran (the most dialysable DOAC — 60% removed in 2-3 hours). After the bleeding source is treated, dabigatran should be restarted (stroke risk from withholding OAC often exceeds rebleeding risk).

Reference: ESC (2024): AF Guidelines