Dabigatran Level Before Reversal Can Predict Hemostatic Effectiveness of Idarucizumab in a Real-World Setting

Figures

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  Figure 1. Initial plasma dabigatran could predict hemostatic effectiveness after reversal. The receiver operating characteristic (ROC) area under the curve (AUC) of the association between baseline plasma dabigatran level and hemostatic efficacy (effective or ineffective) in evaluable patients with major bleeding receiving idarucizumab. Arrow shows that a dabigatran level higher than 264 ng/mL before reversal was a predictor of ineffective hemostasis, with an area under the ROC curve of 0.729 (95% CI 0.50 − 0.97).

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  Figure 2. Initial plasma dabigatran level and biological or clinical outcomes. (A) Kaplan–Meier 90-day survival curve patients after idarucizumab administration according to baseline plasma dabigatran cutoff of 264 ng/mL. Percent survival rate was stratified by dabigatran plasma level at baseline < or ≥264 ng/mL for (n = 33 and 14, respectively) and did not significantly differ between groups (p = 0.36). (B) Initial plasma dabigatran concentrations in patients according to the presence or absence of dabigatran rebound after idarucizumab. Among the 87 patients who had a laboratory test prior to idarucizumab injection, only 16 had plasma dabigatran determination both at baseline and during follow-up. At baseline, patients with no rebound had a significant lower mean of dabigatran level (138 ng/mL ± 114, p = 0.0002) than patients with rebound (1,189 ng/mL ± 869). The dashed red line is a reference line indicating the predefined cutoff of 264 ng/mL. (C) Proportion of cases of dabigatran rebound after reversal according to the cutoff of 264 ng/mL before reversal. No dabigatran rebound was observed after reversal in patients with dabigatran <264 ng/mL at baseline (n = 9, blue bar). Among…

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  Figure 3. The usefulness of dabigatran plasma concentration to guide reversal management and predict hemostatic efficacy after idarucizumab injection.