Reversal of dabigatran and apixaban-induced coagulopathy using idarucizumab, fibrinogen, and prothrombin complex concentrate: A case report
Elia Morando,
Lorenzo Losso,
Massimo Carollo,
Ilaria Costantini,
Matilde Bacchion,
Lucia Drezza,
Giorgio Ricci
Affiliations
Elia Morando
USD Poison Control Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
Lorenzo Losso
USD Poison Control Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
Massimo Carollo
Department of Diagnostics and Public Health, University of Verona, Verona, Italy; Department of Primary Care, AULSS 1 Dolomiti, Belluno, Italy; Corresponding author. Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, VR, Italy.
Ilaria Costantini
USD Poison Control Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
Matilde Bacchion
USD Poison Control Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
Lucia Drezza
USD Poison Control Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Department of Medicine, University of Verona, Verona, Italy; Corresponding author. USD Poison Control Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Giorgio Ricci
USD Poison Control Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
This case report examines the combined use of fibrinogen concentrate, four-factor prothrombin complex concentrate (PCC), and idarucizumab, a specific antidote for dabigatran, to reverse the anticoagulant effects of dabigatran and apixaban-induced coagulopathy. An 86-year-old patient, receiving apixaban therapy, presented to the Emergency Department after intentionally ingesting 50 tablets of dabigatran. The combination therapy contributed to the rapid normalization of coagulation parameters and stabilization of the patient's clinical status without subsequent thromboembolic complications. This case adds to the limited evidence on the effectiveness and safety of combining PCC with idarucizumab in cases of multiple anticoagulant intoxication.
