title: Reversal of Dabigatran Using Idarucizumab in a Septic Patient with Impaired Kidney Function in Real-Life Practice.
abstract: Background. Immediate reversal of anticoagulation is essential when facing severe bleeding or emergency surgery. Although idarucizumab is approved for the reversal of dabigatran in many countries, clinical experiences are lacking, particularly in special patient-populations such as sepsis and impaired renal function. Case Presentation. We present the case of a 67-year-old male septic patient with a multilocular facial abscess and chronic kidney disease (GFR 36.5 mL/min). Thrombin time (TT) and activated partial thromboplastin time (aPTT) 15 hours after the last intake of 150 mg dabigatran were both prolonged (>120 sec, resp., 61 sec), as well as unbound dabigatran concentration (119.05 ng/mL). Before immediate emergency surgery dabigatran was antagonised using idarucizumab 2 × 2.5 g. Dabigatran concentration was not detectable 10 min after idarucizumab administration (<30 ng/mL). TT and aPTT time were normalised (16.2 sec, resp., 30.2 sec). Sepsis was controlled after surgery and kidney function remained stable. In the absence of postoperative bleeding, dabigatran was restarted 36 hours after admission. Conclusion. Idarucizumab successfully reversed the effect of dabigatran in real-life practice in a patient with sepsis and renal impairment and allowed emergency surgery with normal haemostasis. Efficacy and safety in real-life practice will nevertheless require prospective registries monitoring.
authors.affiliation: Department of Emergency Medicine, Inselspital University Hospital, 3011 Bern, Switzerland.
authors.forename: Thomas C
authors.identifier: 0000-0002-6646-5789
authors.initials: TC
authors.lastname: Sauter
authors.affiliation: Department of Emergency Medicine, Inselspital University Hospital, 3011 Bern, Switzerland.
authors.forename: Sina
authors.initials: S
authors.lastname: Blum
authors.affiliation: Department of Haematology and Central Haematology Laboratory, Inselspital University Hospital, 3011 Bern, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Nagler
authors.affiliation: Department of Cranio-Maxillofacial Surgery, Inselspital University Hospital, 3011 Bern, Switzerland.
authors.forename: Fabian L
authors.initials: FL
authors.lastname: Schlittler
authors.affiliation: Department of Emergency Medicine, Inselspital University Hospital, 3011 Bern, Switzerland.
authors.forename: Meret E
authors.identifier: 0000-0003-3047-9350
authors.initials: ME
authors.lastname: Ricklin
authors.affiliation: Department of Emergency Medicine, Inselspital University Hospital, 3011 Bern, Switzerland.
authors.forename: Aristomenis K
authors.initials: AK
authors.lastname: Exadaktylos