title: Rapid and well tolerated action of idarucizumab for antagonizing dabigatran in a patient needing urgent thrombolysis: a case report.
abstract: : Dabigatran is a direct oral anticoagulant drug exhibiting clinical benefits over vitamin K antagonists. A procedure for reversing the anticoagulant effect of direct oral anticoagulants may be needed in emergency clinical settings, and is traditionally accomplished by using plasma products or hemostatic physical interventions. Idarucizumab, a specific antidote for dabigatran, has recently become available. This compound can be rapidly administered by intravenous injection and is effective in reversing anticoagulation in few minutes. We describe here the case of a 78-year-old woman taking dabigatran for atrial fibrillation, who was admitted to the emergency department with a diagnosis of acute cerebral ischemia. Dabigatran plasma levels on admission (74 ng/ml) were measured with diluted thrombin time. Idarucizumab was immediately administered and dabigatran plasma concentration suddenly decreased to less than 2 ng/ml. Successful systemic thrombolysis could hence be performed with full recovery.
authors.affiliation: aLaboratory of Clinical Chemistry and Hematology, General Hospital of Verona bEmergency Department, University Hospital of Verona cSection of Clinical Biochemistry, University of Verona, Verona, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Facchinetti
authors.forename: Giulia
authors.initials: G
authors.lastname: DeGuidi
authors.forename: Federica
authors.initials: F
authors.lastname: Pitoni
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ricci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lippi
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000494:pharmacology / Q000627:therapeutic use*; D000991:Antithrombins / Q000494:pharmacology / Q000627:therapeutic use*; D000069604:Dabigatran / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015912:Thrombolytic Therapy / Q000379:methods*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000991:Antithrombins; C000594745:idarucizumab; D000069604:Dabigatran