Contributions
Abstract: PB2513
Type: Publication Only
Background
Patients who are receiving oral anticoagulant therapy may benefit from anticoagulant reversal if they present life-threatening bleeding or undergoing urgent intervention. Idarucizumab (Praxbind, Boehringer Ingelheim) is a specific reversal agent for dabigatran. It is a humanized monoclonal antibody fragment that binds dabigatran and it is indicated in adult patients when a rapid reversal of its anticoagulant effect is required.
Aims
This is a descriptive study to determine whether idarucizumab would be able to reverse the anticoagulant effect of dabigatran in patients who are about to undergo an urgent procedure.
Methods
The six clinical cases of patients treated with idarucizumab are described.
CASE 1: A 70-year-old woman receiving Dabigatran 150mg/12h who comes to the emergency due to postoperative metrorrhagia. Due to the need of urgent surgery, idarazizumab was given. Hysterectomy with a double annexectomy was made. 20 days later, Dabigatran 150mg/12h was reintroduced without further complications.
CASE 2: A 55-year-old male receiving anticoagulant Dabigatran 150mg/12h, who came to the emergency with complicated renal colic. It was decided to implant double J-catheter, for which we administered idarazizumab. Dabigatran was restarted in 24h at its usual dose, with no new complications thus far.
CASE 3: A 77-year-old woman treated with Dabigatran 110 mg / 12 h goes to the emergency room with urinary tract infection and rectal bleeding. She was treated with Idarucizumab. 1 h after its administration, the diarrhoea continues without evidence of bleeding. 24 h later, she died due to multi-organ failure but without evidence of bleeding.
CASE 4: A 88-year-old woman treated with Dabigatran 110 mg / 12 h goes to the emergency room with 24-hours rectal bleeding. Given the persistence of rectal bleeding 13 h after admission, it was started reversal treatment with Idarucizumab. After 1 hour of administration, there is no evidence of bleeding and there is evidence of normalization of clotting times.
CASO 5: A 86-year-old woman treated with Dabigatran 110 mg / 12 h comes to the emergency room with 48-hours rectorragia. Given the situation of severity with active bleeding, in addition to establishing measures of hydration and transfusion, it was decided to start reversal treatment with Idarucizumab. Improving her general condition progressively, 16 h after its administration, there was an increase in the coagulation times, recovered gradually.
CASE 6: A 76-year-old male, treated with Dabigatran 150 mg / 12 h comes to the emergency room with dizziness and melenic depositions of 3 days of evolution. Although rectal bleeding was not present at this time, it was decided to start reversal treatment with Idarucizumab 2h after admission. 3 h later, there was no evidence of bleeding and the clotting times were normal. 12 h later, there was an increase in coagulation times. Gastrointestinal endoscopy was performed with no evidence of blood remnants or apparent lesions.
Results
The use of idarucizumab permitted rapid and safe intervention of patients. They had normal hemostasis during the procedure. 5 g dose of idarucizumab was sufficient and reversal was maintained for 24 hours.
Conclusion
Idarucizumab is integrated into protocol for the emergency management of patients on dabigatran. Idarucizumab is effective for dabigatran reversal among patients who have uncontrolled bleeding or will be undergoing urgent surgery.
Session topic: 35. Thrombosis and vascular biology & translational Research
Keyword(s): Anticoagulants, Bleeding, Surgery
Abstract: PB2513
Type: Publication Only
Background
Patients who are receiving oral anticoagulant therapy may benefit from anticoagulant reversal if they present life-threatening bleeding or undergoing urgent intervention. Idarucizumab (Praxbind, Boehringer Ingelheim) is a specific reversal agent for dabigatran. It is a humanized monoclonal antibody fragment that binds dabigatran and it is indicated in adult patients when a rapid reversal of its anticoagulant effect is required.
Aims
This is a descriptive study to determine whether idarucizumab would be able to reverse the anticoagulant effect of dabigatran in patients who are about to undergo an urgent procedure.
Methods
The six clinical cases of patients treated with idarucizumab are described.
CASE 1: A 70-year-old woman receiving Dabigatran 150mg/12h who comes to the emergency due to postoperative metrorrhagia. Due to the need of urgent surgery, idarazizumab was given. Hysterectomy with a double annexectomy was made. 20 days later, Dabigatran 150mg/12h was reintroduced without further complications.
CASE 2: A 55-year-old male receiving anticoagulant Dabigatran 150mg/12h, who came to the emergency with complicated renal colic. It was decided to implant double J-catheter, for which we administered idarazizumab. Dabigatran was restarted in 24h at its usual dose, with no new complications thus far.
CASE 3: A 77-year-old woman treated with Dabigatran 110 mg / 12 h goes to the emergency room with urinary tract infection and rectal bleeding. She was treated with Idarucizumab. 1 h after its administration, the diarrhoea continues without evidence of bleeding. 24 h later, she died due to multi-organ failure but without evidence of bleeding.
CASE 4: A 88-year-old woman treated with Dabigatran 110 mg / 12 h goes to the emergency room with 24-hours rectal bleeding. Given the persistence of rectal bleeding 13 h after admission, it was started reversal treatment with Idarucizumab. After 1 hour of administration, there is no evidence of bleeding and there is evidence of normalization of clotting times.
CASO 5: A 86-year-old woman treated with Dabigatran 110 mg / 12 h comes to the emergency room with 48-hours rectorragia. Given the situation of severity with active bleeding, in addition to establishing measures of hydration and transfusion, it was decided to start reversal treatment with Idarucizumab. Improving her general condition progressively, 16 h after its administration, there was an increase in the coagulation times, recovered gradually.
CASE 6: A 76-year-old male, treated with Dabigatran 150 mg / 12 h comes to the emergency room with dizziness and melenic depositions of 3 days of evolution. Although rectal bleeding was not present at this time, it was decided to start reversal treatment with Idarucizumab 2h after admission. 3 h later, there was no evidence of bleeding and the clotting times were normal. 12 h later, there was an increase in coagulation times. Gastrointestinal endoscopy was performed with no evidence of blood remnants or apparent lesions.
Results
The use of idarucizumab permitted rapid and safe intervention of patients. They had normal hemostasis during the procedure. 5 g dose of idarucizumab was sufficient and reversal was maintained for 24 hours.
Conclusion
Idarucizumab is integrated into protocol for the emergency management of patients on dabigatran. Idarucizumab is effective for dabigatran reversal among patients who have uncontrolled bleeding or will be undergoing urgent surgery.
Session topic: 35. Thrombosis and vascular biology & translational Research
Keyword(s): Anticoagulants, Bleeding, Surgery