Use of Idarucizumab as Dabigatran Antagonist Prior to Burr Hole Surgery for Patients with Chronic Subdural Hematoma

Idarucizumab is a monoclonal antibody fragment with high affinity for dabigatran that reverses its anticoagulant effect within minutes.We present 3 patients with atrial fibrillation on dabigatran therapy for prevention of stroke and systemic embolism in which urgent surgeries were needed for chronic subdural hematomas with mass effects.Idarucizumab was successfully used to reverse dabigatran effects and to ensure immediate surgery without bleeding complication.Afterwards 4 burr hole trepanations with drainages placement were performed on the 3 patients (in one patient bilaterally) without complications.Follow-up CT scans revealed satisfactory and persistent removal of hematomas and mass effects suggesting that idarucizumab can be used safely and effectively as a specific reversal agent for dabigatran prior to emergent surgery.