title: Real-life experience with the specific reversal agent idarucizumab for the management of emergency situations in dabigatran-treated patients: a series of 11 cases.
abstract: Non-vitamin K antagonist oral anticoagulants (NOACs) have a favorable benefit-risk profile compared with vitamin K antagonists. However, the lack of specific reversal agents has made the management of some patients receiving long-term treatment with NOACs problematic in emergency situations such as major bleeding events or urgent procedures. Idarucizumab, a fully humanized Fab antibody fragment that binds specifically and with high affinity to dabigatran, was recently approved for use in adult patients treated with dabigatran when rapid reversal of its anticoagulant effect is required. Clinical experience with idarucizumab is currently limited. We report 11 real-life clinical cases in which idarucizumab was used after multidisciplinary consultation in a variety of emergency situations including severe postoperative bleeding, emergency high-bleeding-risk surgery (hip/spine surgery and neurosurgery), invasive diagnostic testing (lumbar puncture), intracranial bleeding (pre-pontine subarachnoid hemorrhage and lobar intracerebral hemorrhage) and thrombolysis with recombinant tissue plasminogen activator for acute ischemic stroke. This case series illustrates the role of idarucizumab in improving patient safety in rare emergency situations requiring rapid reversal of the anticoagulant effect of dabigatran, while highlighting the importance of information and education about the availability and appropriate use of this recently approved specific reversal agent.
authors.affiliation: Department of Neurology 2, Kepler Universitätsklinikum, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria. milan.vosko@kepleruniklinikum.at.
authors.forename: Milan R
authors.initials: MR
authors.lastname: Vosko
authors.affiliation: Department of Neurology, KonventhospitalBarmherzige Brueder Linz, Linz, Austria.
authors.forename: Christof
authors.initials: C
authors.lastname: Bocksrucker
authors.affiliation: Department of Anesthesiology and Intensive Care, John Paul II Hospital, Medical College of Jagiellonian University, Krakow, Poland.
authors.forename: Rafał
authors.initials: R
authors.lastname: Drwiła
authors.affiliation: Fourth Department of Internal Medicine, Hematology, Hradec Králové Faculty of Medicine, Hradec Králové University Hospital, Hradec Králové, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Dulíček
authors.affiliation: Department of Internal Medicine, České Budějovice Regional Hospital, and Faculty of Health and Science, University of South Bohemia, České Budějovice, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Hauer
authors.affiliation: Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Mutzenbach
authors.affiliation: Department of Anesthesiology and Intensive Care, AUVA Trauma Hospital, Klagenfurt, Austria.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Schlimp
authors.affiliation: Department of Internal Medicine, Ústí nad Orlicí Hospital, Ústí nad Labem, Czech Republic.|Department of Cardiology, Pardubice Regional Hospital, Pardubice, Czech Republic.
authors.forename: David
authors.initials: D
authors.lastname: Špinler
authors.affiliation: Department of Neurology, Wiener Neustadt Regional Hospital, Wiener Neustadt, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wolf
authors.affiliation: General Hospital Jesenice, Jesenice, Slovenia.
authors.forename: Daša
authors.initials: D
authors.lastname: Zugwitz
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000991:Antithrombins / Q000009:adverse effects; D000069604:Dabigatran / Q000009:adverse effects*; D019468:Disease Management; D004347:Drug Interactions; D004630:Emergencies; D006470:Hemorrhage / Q000139:chemically induced / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D020300:Intracranial Hemorrhages / Q000188:drug therapy; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000009:adverse effects
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000991:Antithrombins; C000594745:idarucizumab; D000069604:Dabigatran
keywords: Anticoagulation reversal; Critical bleeding; Direct oral anticoagulants; Emergency procedures; Non-valvular atrial fibrillation; Non-vitamin K antagonist oral anticoagulants