Drug Interactions between dabigatran and LMD with 5% Dextrose

GENERALLY AVOID: Drugs that can affect hemostasis such as glycoprotein IIb/IIIa inhibitors, thienopyridine antiplatelet agents, unfractionated and low molecular weight heparins, heparin derivatives, hirudin derivatives and analogs, thrombolytics, dextran, vitamin K antagonists, factor Xa inhibitors and other anticoagulants may potentiate the risk of bleeding complications associated with the use of dabigatran.

MANAGEMENT: In general, any agent that can enhance the risk of hemorrhage including other anticoagulants should be discontinued prior to initiation of dabigatran therapy. If coadministration is necessary, it should be undertaken with caution and only after thorough assessment of risks and benefits. A 24-hour interval is recommended before switching from dabigatran to parenteral anticoagulation. When switching from parenteral anticoagulation to dabigatran, the first dose of dabigatran should not be given before the next scheduled time of the parenteral anticoagulant dose. Unfractionated heparin may be used concomitantly at doses necessary to maintain intravenous or arterial catheter patency. Close clinical and laboratory observation for bleeding complications is recommended.

GENERALLY AVOID: In patients receiving neuraxial anesthesia or spinal puncture, the risk of developing an epidural or spinal hematoma during dabigatran therapy may be increased by the concomitant use of other drugs that affect coagulation. The development of epidural and spinal hematoma can lead to long-term or permanent paralysis.

MANAGEMENT: In patients undergoing neuraxial intervention, administration of dabigatran alone or with other drugs that can affect hemostasis should be approached with extreme caution and only after thorough assessment of risks and benefits. Besides bleeding complications, these patients should also be monitored frequently for signs and symptoms of neurologic impairment such as midline back pain, sensory and motor deficits (numbness or weakness in lower limbs), and bowel or bladder dysfunction. Urgent diagnosis and treatment (e.g., spinal cord decompression) are required if signs or symptoms of spinal hematoma develop. To reduce the potential risk of bleeding, placement or removal of an epidural catheter or lumbar puncture should ideally be performed when the anticoagulant effect of dabigatran is low. An optimal interval has not been established, but should take into consideration the pharmacokinetic profile of dabigatran.