Lessons learnt from local real-life experience with idarucizumab for the reversal of dabigatran.
Aged
Aged, 80 and over
Antibodies, Monoclonal, Humanized
/ therapeutic use
Anticoagulants
/ therapeutic use
Australia
Blood Coagulation
/ drug effects
Dabigatran
/ administration & dosage
Female
Hemorrhage
/ drug therapy
Humans
Male
Middle Aged
Partial Thromboplastin Time
Renal Insufficiency
/ physiopathology
Retrospective Studies
Thrombin Time
Pradaxa
Praxbind
anticoagulation
dabigatran
idarucizumab
reversal
Journal
Internal medicine journal
ISSN: 1445-5994
Titre abrégé: Intern Med J
Pays: Australia
ID NLM: 101092952
Informations de publication
Date de publication:
Jan 2019
Jan 2019
Historique:
received:
06
02
2018
revised:
22
04
2018
accepted:
27
05
2018
pubmed:
6
6
2018
medline:
21
9
2019
entrez:
6
6
2018
Statut:
ppublish
Résumé
Idarucizumab is a specific antidote for the direct thrombin inhibitor oral anticoagulant dabigatran etexilate. It has been used with increasing frequency in Australia since it was granted Therapeutic Goods Administration approval in October 2016. To assess idarucizumab usage, effect on coagulation parameters and clinical outcomes in patients who received idarucizumab in Western Sydney Local Health District (WSLHD). A retrospective audit was conducted of all patients who received idarucizumab in WSLHD between September 2015 and December 2017. Of the 23 patients who received idarucizumab, 17 (74%) had bleeding, and 6 (26%) required urgent surgery/procedure. Thrombin time (TT) or activated partial thromboplastin time (APTT, when TT not available) remained prolonged at 24 h post-idarucizumab infusion in 10 of 20 (50%) patients. Renal impairment at admission was associated with prolonged TT/APTT at 24 h (P = 0.02). Of the six (26%) patients who died during hospital admission, five had raised TT/APTT at 24 h (P = 0.05). Two deaths were due to continued bleeding despite idarucizumab. Only 17% of patients received prohaemostatic treatments, and none received plasma derivatives. Despite assay availability, dabigatran drug level was only measured in eight patients. Idarucizumab helped achieve haemostasis in 15 bleeding patients and allowed 6 patients to undergo urgent surgery. Half the patients had prolonged TT/APTT at 24 h post-idarucizumab, which was more likely to occur in patients with impaired renal function.
Sections du résumé
BACKGROUND
BACKGROUND
Idarucizumab is a specific antidote for the direct thrombin inhibitor oral anticoagulant dabigatran etexilate. It has been used with increasing frequency in Australia since it was granted Therapeutic Goods Administration approval in October 2016.
AIMS
OBJECTIVE
To assess idarucizumab usage, effect on coagulation parameters and clinical outcomes in patients who received idarucizumab in Western Sydney Local Health District (WSLHD).
METHODS
METHODS
A retrospective audit was conducted of all patients who received idarucizumab in WSLHD between September 2015 and December 2017.
RESULTS
RESULTS
Of the 23 patients who received idarucizumab, 17 (74%) had bleeding, and 6 (26%) required urgent surgery/procedure. Thrombin time (TT) or activated partial thromboplastin time (APTT, when TT not available) remained prolonged at 24 h post-idarucizumab infusion in 10 of 20 (50%) patients. Renal impairment at admission was associated with prolonged TT/APTT at 24 h (P = 0.02). Of the six (26%) patients who died during hospital admission, five had raised TT/APTT at 24 h (P = 0.05). Two deaths were due to continued bleeding despite idarucizumab. Only 17% of patients received prohaemostatic treatments, and none received plasma derivatives. Despite assay availability, dabigatran drug level was only measured in eight patients.
CONCLUSION
CONCLUSIONS
Idarucizumab helped achieve haemostasis in 15 bleeding patients and allowed 6 patients to undergo urgent surgery. Half the patients had prolonged TT/APTT at 24 h post-idarucizumab, which was more likely to occur in patients with impaired renal function.
Substances chimiques
Antibodies, Monoclonal, Humanized
0
Anticoagulants
0
idarucizumab
97RWB5S1U6
Dabigatran
I0VM4M70GC
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
59-65Informations de copyright
© 2018 Royal Australasian College of Physicians.