A 67-year-old man on dabigatran for AF presents after a fall. Drowsy, GCS 13. O/E: Right-sided weakness, BP 168/95. CT head: Large acute subdural haematoma, 8mm midline shift. Neurosurgery advise urgent evacuation.
Investigations:
- HR: 110/min
- BP: 168/95 mmHg
- GCS: 13 (E3 V4 M6)
- Pupils: Equal and reactive
What is the MOST appropriate immediate management of his anticoagulation?
A
Give IV Vitamin K 10mg and prothrombin complex concentrate (PCC).
B
Give idarucizumab 5g IV as two separate 2.5g bolus infusions.
C
Withhold the dabigatran and give activated charcoal via an NG.
D
Give IV tranexamic acid 1g and fresh frozen plasma at 15ml/kg.
E
Start emergent haemodialysis and delay the surgery for 24 hours.