Title: How Do I Emergently Reverse Dabigatran?
题目：如何急诊拮抗达比加群
Author 作者: Feras Khan
翻译：葛赟 校正：肖锋

What is it:
这是什么
Direct thrombin inhibitor used for stroke prevention in non-valvular atrial fibrillation
对非瓣膜性房颤患者使用直接凝血酶抑制剂可预防脑卒中。
When do I worry about reversal:
什么时候要考虑进行拮抗
Patients can have clinically important bleeding (GI hemorrhage, or Intracranial bleeding) or need reversal for emergent surgery
临床上，患者有出血风险（胃肠道出血，或颅内出血）或需要急诊手术。
Patients with renal failure can have a prolonged medication effect
肾衰病人的药物作用时间有可能延长。
What can I do:
我能做什么：
1.     Activated charcoal: good for recent overdose or recent ingestion (within 2 hours)
活化的活性炭：对近期药物过量使用或近期摄入的患者有帮助（2小时内）
2.     Hemodialysis:  around 60-65% can be removed within 2-4 hrs; putting in a dialysis line can be…bloody
血液透析：在2-4小时内可清除约60-65%药物，放置透析管可能造成出血。
3.     FFP: in rat studies, has been shown to reduce the volume of intracranial hemorrhage. Unknown in humans. No good evidence of use based on coagulation mechanisms. Still worth a try though. 
新鲜冰冻血浆：在大鼠实验中，可减少颅内出血量。在人体实验中还未证实。根据凝血机制，新鲜冰冻血浆的使用还没有足够的证据。但是仍然值得一试。
4.     Recombinant activated factor VII: Has been shown to correct the bleeding time in animal studies. Probably the best bet in severe bleeding
重组激活因子VII：在动物实验中，已证实能纠正出血时间。在严重出血中可能是最好的选择。
5.     Pro-thrombin complex concentrate: has been shown to decrease the bleeding time in animal studies
凝血酶原复合物：在动物实验中已证实能减少出血时间。
How do I monitor effect?
如何监测效果？
No great way here. Check aPTT and thrombin time (TT). At supra-therapeutic doses there is no good test. 
这里没有好的方法。检测活化部分凝血酶时间（APTT）和凝血酶时间（TT）。超治疗剂量使用时没有好的检测方法。
References 参考文献：
Kaatz, S et al. Guidance on the emergent reversal of oral thrombin and factor Xa inhibitors. American Journal of Hematology. 2012.