title: Reversal of dabigatran by idarucizumab: when and how?
abstract: BACKGROUND
  Anticoagulants are highly effective in reducing the risk of embolism in patients with atrial fibrillation and in the treatment of venous thromboembolism. However, interfering with the coagulation system increases the risk of bleeding. Non-vitamin K oral anticoagulants (NOACs) are associated with a reduced risk of major and life-threatening bleeding compared to warfarin, but the absence of a specific reversal agent has caused concern among clinicians.
  
  
  METHODS
  This article describes the indications for and practical use of idarucizumab, a specific reversal agent for the direct thrombin inhibitor dabigatran. Expert commentary: Each year, 3-5% of anticoagulated patients will experience major bleeding and about 10% will require invasive interventions. While most of these situations can be managed without the need for a reversal agent, the ability to promptly switch off anticoagulant activity is likely beneficial in severe bleeding situations and can help to avoid delays and improve safety in the management of patients requiring urgent procedures. Idarucizumab rapidly and completely reverses the anticoagulant effect of dabigatran in vitro, in healthy volunteers, and in patients presenting with severe bleeding or requiring urgent procedures. Further clinical data will help to understand the clinical impact of rapid reversal on the outcome of bleeding patients.
authors.affiliation: a Department of Cardiovascular Sciences , University Hospitals Leuven , Leuven , Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Vanassche
authors.affiliation: b Institute for Immunology and Transfusion Medicine , University Medicine Greifswald , Greifswald , Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Greinacher
authors.affiliation: a Department of Cardiovascular Sciences , University Hospitals Leuven , Leuven , Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Verhamme
mesh_terms: D000818:Animals; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D001281:Atrial Fibrillation / Q000150:complications; D001777:Blood Coagulation / Q000187:drug effects; D000069604:Dabigatran / Q000008:administration & dosage / Q000009:adverse effects* / Q000037:antagonists & inhibitors / Q000493:pharmacokinetics; D019468:Disease Management; D055808:Drug Discovery; D004353:Drug Evaluation, Preclinical; D006470:Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D054556:Venous Thromboembolism / Q000150:complications / Q000188:drug therapy / Q000209:etiology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000925:Anticoagulants; D000991:Antithrombins; C000594745:idarucizumab; D000069604:Dabigatran
keywords: Idarucizumab; NOACs; anticoagulants; dabigatran; reversal agent