Position Papers



Dabigatran Etexilate: Management of bleeding complications for patients taking this medication
Theresa Nester, MD and Barbara Konkle, MD

Dabigatran etexilate is an oral direct thrombin inhibitor. It has been approved by the FDA for use in atrial fibrillation, following a study published in 2009 which suggested it was as efficacious and had a better safety profile than warfarin, in terms of bleeding risk. Dabigatran is a small molecule that shows low plasma protein binding.



Role of Prothrombin Complex Concentrates in Reversing Warfarin Anticoagulation
Neil Josephson, MD and Theresa Nester, MD

Over the past year, several King County Hospitals have asked for our opinion on using prothrombin complex concentrates (PCCs) to reverse warfarin anticoagulation in patients with intracranial hemorrhage (ICH) and other life threatening bleeding episodes. The annual incidence of fatal bleeding in patients on warfarin is approximately 1%, with ICH accounting for the majority of cases. Warfarin interferes with production of the vitamin K dependent coagulation factors II, VII, IX, and X.



Platelet Bacterial Safety – What's Next?
James P. AuBuchon, MD, FCAP, FRCP (Edin)

In accordance with AABB Standards, all platelet units are collected using steps to limit the potential for bacterial contamination and are tested to detect bacteria prior to their release or issue. While any test has the potential for false negativity and failing to detect the target agent, culturing platelet units has yielded less safety than anticipated. Currently, there are multiple discussions ongoing by regulatory agencies and accrediting bodies whether additional detection steps should be implemented.

The Clinical Use of O Negative Red Blood Cells
James P. AuBuchon, MD, FCAP, FRCP (Edin)

O negative red cell donors and their donated units are a scarce resource. There are appropriate indications for use, such as for untyped or O negative women of childbearing age. However, use of Rh positive blood is recommended in many other situations for both untyped and large volume transfusions.