Late rebound of dabigatran levels after idarucizumab reversal in two patients with severe renal failure

Stecher, Adela; Vene, Nina; Mavri, Alenka; Mijovski, Mojca Božič; Krevel, Barbara; Gradišek, Primož

doi:10.1097/eja.0000000000000617

Cited by 11 publications

(3 citation statements)

References 9 publications

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“…Studies have shown a small number of patients' experience rebound in TT, particularly in obese patients or patients with dabigatran overdose and high serum levels. 8,11 The clinical significance of this is uncertain, but if there is concern of ongoing bleeding and TT remains elevated, a repeat dose and/or haemodialysis can be considered. 12,13 Where TT were completed, effective reversal was demonstrated by both laboratory and clinical parameters.…”

Section: Discussionmentioning

confidence: 99%

Idarucizumab for dabigatran reversal: the first 6 months in a tertiary centre

Wheeler

Borrie

Dookia

et al. 2019

Internal Medicine Journal

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This retrospective audit reviews patients on dabigatran presenting with bleeding or requiring urgent surgery in the Wellington region, whether they received idarucizumab appropriately and the outcome of episodes. Eighty patients were identified with bleeding or need for urgent surgery, 14 of which received idarucizumab. In patients who received idarucizumab, use was safe, effective and overall appropriate. Idarucizumab was underutilised with patients who could have benefited not receiving it; however, some patients who were treated may not have required it. Increased awareness and use may improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Idarucizumab for dabigatran reversal: the first 6 months in a tertiary centre

Wheeler

Borrie

Dookia

et al. 2019

Internal Medicine Journal

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“…It is important to note, however, that both patients had complex medical conditions that contributed to their hemostasis imbalance. Another example of therapeutic failure was in the case of an 87-year-old patient with severe renal failure who had a rebound of dabigatran levels after idarucizumab, which necessitated additional hemodialysis and subsequent management with heparin [65]. In another case report, life-threatening gastrointestinal bleeding persisted after the administration of idarucizumab, such that additional supportive therapy, including emergent angiography and FEIBA administration, was warranted [66].…”

Section: Direct Thrombin Inhibitor-dabigatran-and Its Reversalmentioning

confidence: 99%

Direct-Acting Oral Anticoagulants and Their Reversal Agents—An Update

Kustos

Fasinu

2019

Medicines

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Background: Over the last ten years, a new class of drugs, known as the direct-acting oral anticoagulants (DOACs), have emerged at the forefront of anticoagulation therapy. Like the older generation anticoagulants, DOACs require specific reversal agents in cases of life-threatening bleeding or the need for high-risk surgery. Methods: Published literature was searched, and information extracted to provide an update on DOACS and their reversal agents. Results: The DOACs include the direct thrombin inhibitor—dabigatran, and the factor Xa inhibitors—rivaroxaban, apixaban, edoxaban, and betrixaban. These DOACs all have a rapid onset of action and each has a predictable therapeutic response requiring no monitoring, unlike the older anticoagulants, such as warfarin. Two reversal agents have been approved within the last five years: idarucizumab for the reversal of dabigatran, and andexanet alfa for the reversal of rivaroxaban and apixaban. Additionally, ciraparantag, a potential “universal” reversal agent, is currently under clinical development. Conclusions: A new generation of anticoagulants, the DOACs, and their reversal agents, are gaining prominence in clinical practice, having demonstrated superior efficacy and safety profiles. They are poised to replace traditional anticoagulants including warfarin.

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“…Importantly, rebound dabigatran concentrations have also been reported after idarucizumab administration in the setting of severe renal failure. 90…”

Section: Idarucizumabmentioning

confidence: 99%

Reversal of Oral Anticoagulants for Intracerebral Hemorrhage Patients: Best Strategies

Fuh

Sin

Goldstein

et al. 2017

Semin Respir Crit Care Med

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In patients with acute intracerebral hemorrhage (ICH), one of the major concerns is ongoing bleeding or ICH expansion. Anticoagulated patients are at higher risk of ongoing expansion and worse outcome. It may be that rapid anticoagulation reversal can reduce the risk of expansion and improve clinical outcome. For those taking coumarins, the best available evidence suggests that intravenous vitamin K combined with four-factor prothrombin complex concentrate (4F-PCC) is the most rapid and effective regimen to restore hemostasis. For those on dabigatran, the highest quality data available for reversal are for idarucizumab, although it is not yet clear whether patients derive clinical benefit from this reversal. In the absence or failure of idarucizumab, activated prothrombin complex concentrate (aPCC) is recommended. For those on factor Xa inhibitors, the ideal reversal agent is not clear. Many providers use 4F-PCC or aPCC, but more specific agents are in clinical trials and may soon be available. In addition, the half-lives of the non-vitamin K antagonists are relatively short compared with warfarin, and so some patients may not have a clinically relevant coagulopathy at the time of presentation. Overall, the optimal reversal agent, when one is required, is a function of which anticoagulant the patient is taking.

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Late rebound of dabigatran levels after idarucizumab reversal in two patients with severe renal failure

Cited by 11 publications

References 9 publications

Idarucizumab for dabigatran reversal: the first 6 months in a tertiary centre

Idarucizumab for dabigatran reversal: the first 6 months in a tertiary centre

Direct-Acting Oral Anticoagulants and Their Reversal Agents—An Update

Reversal of Oral Anticoagulants for Intracerebral Hemorrhage Patients: Best Strategies

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