Idarucizumab for Reversal of Dabigatran in Early/Emergency Surgeries: A Case Series.
Aged
Aged, 80 and over
Antibodies, Monoclonal, Humanized
/ administration & dosage
Antidotes
/ administration & dosage
Antithrombins
/ therapeutic use
Case-Control Studies
Dabigatran
/ antagonists & inhibitors
Female
Humans
Male
Middle Aged
Retrospective Studies
Surgical Procedures, Operative
/ methods
Streaming video: Three video clips that accompany this article are available at www.journals.elsevierhealth.com/periodicals/jem.
anticoagulation reversal
dabigatran
emergency surgery
idarucizumab
intracerebral hemorrhage
subdural hematoma
Journal
The Journal of emergency medicine
ISSN: 0736-4679
Titre abrégé: J Emerg Med
Pays: United States
ID NLM: 8412174
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
received:
24
07
2019
revised:
26
08
2019
accepted:
20
09
2019
pubmed:
31
10
2019
medline:
25
8
2020
entrez:
31
10
2019
Statut:
ppublish
Résumé
Idarucizumab is a humanized, monoclonal antibody fragment used specifically to reverse the anticoagulant effects of dabigatran. We discuss 4 cases of patients who were treated with idarucizumab to reverse dabigatran before early/emergency surgery. Two of the patients had subdural hematomas, 1 had a splenic laceration, and 1 had Fournier gangrene. All patients received 5 g of idarucizumab before surgery. Intraoperative blood loss in all patients was normal, no adverse events were reported, and the patients recovered normally. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The case reports presented provide detailed, practical, real-world experience beyond that reported in other case reports and the Reversal Effects of Idarucizumab on Active Dabigatran study. This can help guide clinicians on how idarucizumab can reverse the anticoagulant effect of dabigatran in emergency situations, including patients with subdural hematoma. Our experience suggests that idarucizumab may be a safe and effective antidote to the effects of dabigatran in real-life bleeding situations involving early or emergency surgeries.
Sections du résumé
BACKGROUND
BACKGROUND
Idarucizumab is a humanized, monoclonal antibody fragment used specifically to reverse the anticoagulant effects of dabigatran.
CASE REPORTS
METHODS
We discuss 4 cases of patients who were treated with idarucizumab to reverse dabigatran before early/emergency surgery. Two of the patients had subdural hematomas, 1 had a splenic laceration, and 1 had Fournier gangrene. All patients received 5 g of idarucizumab before surgery. Intraoperative blood loss in all patients was normal, no adverse events were reported, and the patients recovered normally. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The case reports presented provide detailed, practical, real-world experience beyond that reported in other case reports and the Reversal Effects of Idarucizumab on Active Dabigatran study. This can help guide clinicians on how idarucizumab can reverse the anticoagulant effect of dabigatran in emergency situations, including patients with subdural hematoma. Our experience suggests that idarucizumab may be a safe and effective antidote to the effects of dabigatran in real-life bleeding situations involving early or emergency surgeries.
Identifiants
pubmed: 31662218
pii: S0736-4679(19)30821-2
doi: 10.1016/j.jemermed.2019.09.038
pii:
doi:
Substances chimiques
Antibodies, Monoclonal, Humanized
0
Antidotes
0
Antithrombins
0
idarucizumab
97RWB5S1U6
Dabigatran
I0VM4M70GC
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e167-e173Informations de copyright
Copyright © 2019 The Author(s). Published by Elsevier Inc. All rights reserved.