Background and Importance The evaluation of anticoagulation reversal practices of direct-acting oral anticoagulants allows their optimisation by improving their safety and efficiency.
Aim and Objectives To review the use of idarucizumab in the reversal of the effect of dabigatran and to evaluate its effectiveness in the normalisation of coagulation parameters and clinical evolution of the patient.
Material and Methods Descriptive, observational, retrospective study of all patients who received idarucizumab in the period from December 2015 to June 2022, inclusive, in a tertiary hospital. Data were collected from the electronic medical record. Variables assessed were: demographics (age, sex); coagulation parameters [activated partial thromboplastin time (aPTT)]; indication and dose of dabigatran; reason for prescription and dose of idarucizumab; response to treatment (normalisation of aPTT and clinical evolution).
Results Fifty-four patients prescribed idarucizumab were identified. One patient was excluded because active treatment was declined (n=53). Median age was 82 years (RIQ: 75-88.5), 58.5% male and 41.5% female. The indication for dabigatran was stroke prevention and systemic embolism due to non-valvular atrial fibrillation in 52 patients and stroke in 1 patient. The doses of dabigatran reported in the medical records were: 150 mg/12 h in 16 patients, 110 mg/12 in 34 patients and 75 mg/12 in 1 patient (no data in 2 patients). Thirty-six patients received idarucizumab for major bleeding, 12 for urgent surgery, 3 for urgent invasive procedure and 2 for supratherapeutic levels of dabigatran. In all cases the indication was established by the haematology department. Median aPTT before antidote administration was 46.95 seconds (RIQ: 35.2-52.5) (n=52); 1 patient had supratherapeutic levels of dabigatran, showing incoagulable. Median aPTT after idarucizumab administration was 27.4 seconds (RIQ: 25-29.8) (no post-administration aPTT values in 6 patients). The dose of idarucizumab was 5 g in all cases. Four patients died. In 49 patients treatment was effective with no episodes of rebleeding or thromboembolism.
Conclusion and Relevance Idarucizumab was mostly used in major bleeding. Treatment was effective in 92% of the study population.
Conflict of Interest No conflict of interest
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