Rapid Reversal of Dabigatran Anticoagulation With Idarucizumab
BERLIN — Using the monoclonal antibody reversal agent idarucizumab (Praxbind, Boehringer Ingelheim), researchers have shown rapid, complete, and sustained reversal of dabigatran etexilate (Pradaxa, Boehringer Ingelheim) anticoagulation in a cohort of elderly, multimorbid patients with life-threatening emergencies.
Patients in this study, RE-VERSE AD, required reversal of anticoagulation because of uncontrolled bleeding or because they needed emergency surgery or an invasive procedure.
"Among bleeding patients who were reversed, the median time to investigator-reported hemostasis was 2.5 hours," said lead researcher Dr Charles Pollack (Thomas Jefferson University in Philadelphia, PA).
For patients undergoing invasive procedures, "nearly all of these 202 patients actually underwent the procedure for which they were reversed, [and] then at the time of their procedure 93.4% were reported to have hemostasis as if they had not been anticoagulated," he said. All of the remaining 6.6% had only mildly to moderately abnormal hemostasis. The median time from reversal to procedure was 1.6 hours.
Laboratory studies were consistent with the observed cessation of bleeding. "The [diluted thrombin time] dTT normalized at nearly 99% of all bleeding and preprocedure patients by 4 hours," Dr Pollack said.
The results were reported here at the International Society on Thrombosis and Haemostasis 2017 Congress and published online July 11, 2017 in the New England Journal of Medicine.