Clinical course of dabigatran-associated massive postcardiac surgery bleeding. (A) Blood products administered, aPTT, INR, and fibrinogen (Fbg) over time. (B) Thrombin-clotting time (TCT) and plasma dabigatran levels. The inset shows TCT and dabigatran levels during the 17- to 137-hour postoperative period. Note: all TCT values shown did not decrease on in vitro addition of protamine (not shown), thus ruling out heparin as an explanation for the patient's prolonged TCTs. (C) Bleeding (chest/pericardial tube output/hr). p₂ and p₁ refer to blood samples obtained during stable dabigatran dosing 2 and 1 month, respectively, before surgery. rFVIIa indicates recombinant factor VIIa.