Intravenous idarucizumab rapidly reduced dabigatran plasma concentration from 74 ng/ml to less than 2 ng/ml, allowing for successful systemic thrombolysis and full recovery in a 78-year-old woman.
Case Report (n=1)
Does idarucizumab rapidly reverse dabigatran anticoagulation to allow urgent systemic thrombolysis in a patient with acute cerebral ischemia?
Idarucizumab rapidly and effectively reverses dabigatran anticoagulation, enabling urgent and successful systemic thrombolysis in acute ischemic stroke.
: Dabigatran is a direct oral anticoagulant drug exhibiting clinical benefits over vitamin K antagonists. A procedure for reversing the anticoagulant effect of direct oral anticoagulants may be needed in emergency clinical settings, and is traditionally accomplished by using plasma products or hemostatic physical interventions. Idarucizumab, a specific antidote for dabigatran, has recently become available. This compound can be rapidly administered by intravenous injection and is effective in reversing anticoagulation in few minutes. We describe here the case of a 78-year-old woman taking dabigatran for atrial fibrillation, who was admitted to the emergency department with a diagnosis of acute cerebral ischemia. Dabigatran plasma levels on admission (74 ng/ml) were measured with diluted thrombin time. Idarucizumab was immediately administered and dabigatran plasma concentration suddenly decreased to less than 2 ng/ml. Successful systemic thrombolysis could hence be performed with full recovery.
Facchinetti et al. (2017) conducted a case report in Acute cerebral ischemia in a patient taking dabigatran for atrial fibrillation (n=1). Idarucizumab was evaluated on Dabigatran plasma concentration and successful systemic thrombolysis. Intravenous idarucizumab rapidly reduced dabigatran plasma concentration from 74 ng/ml to less than 2 ng/ml, allowing for successful systemic thrombolysis and full recovery in a 78-year-old woman.