Idarucizumab for Dabigatran Reversal — Full Cohort Analysis

Management of bleeding or urgent interventions in patients treated with direct oral anticoagulants (DOACs) - 2017 management proposals in Poland

“…The efficacy and safety of idarucizumab were demonstrated in a group of 90 patients with severe bleeding or who required urgent surgery or invasive procedures. 15 Adverse reactions were observed in no more than 5% of the patients and included headache and hypokalemia. No prothrombotic effect of idarucizumab has been reported so far.…”

“…Idarucizumab causes an immediate and full reversal of dabigatran effects and enables an urgent procedure of intracranial hematoma removal. 15 The preparation for a surgical intervention in cases of intracranial hemorrhage is the same as for procedures associated with high bleeding risk (TAbLE 1). The time for discontinuation of DOACs depends on creatinine clearance.…”

“…No prothrombotic effect of idarucizumab has been reported so far. 15 Idarucizumab should be used in patients with life -threatening bleeding or before urgent major surgeries (TAbLE 4). [16][17][18] Andexanet alfa, an analogue of factor Xa, a potential antidote to rivaroxaban, apixaban, edoxaban, heparin, low -molecular -weight heparin, and fondaparinux, is currently under investigation.…”

Antidotbehandling ved bruk av direktevirkende antikoagulasjonsmidler

“…I underkant av 5 % av pasientene i RE-VERSE AD-studien utviklet tromboemboliske hendelser i løpet av de første 30 dagene etter administrasjon av idarusizumab. Blant disse hadde 2/3 ikke gjenopptatt antikoagulasjonsbehandling på tidspunktet hendelsen inntraff (26).…”

Reversal Agents: What We Have and What We Can Expect

“…36 The primary endpoint was the maximum percentage reversal of the anticoagulant effect of dabigatran within four hours of completion of the idarucizumab infusions, on the basis of central laboratory measurement of the patients' dilute thrombin time or ecarin clotting time. Key secondary endpoints included the time to cessation of bleeding in group A and the assessment of hemostasis during intervention administration in group B.…”