Dabigatrin (Pradaxa®) is a new anti-coagulant (direct thrombin inhibitor) that can be used instead of warfarin. If a potential bleeder is taking it: be afraid.
It doesn’t change the INR, so it can really sneak up on you. If you’re suspicious send coags (write “on dabigatrin/time of last dose”). A normal to mildly elevated INR, a prolonged aPPT and a elevated echis ratio means they are anticoagulated.
Surgical homeostasis is still important, and dialysis is the only proven reversal agent, but IVF, RBCs, FFPs, Plts, Tranexamic acid, PCC, Cryo, and/or Factor VII may help. Contact hematology early.