Vascular Health and Risk Management (May 2019)
Practical considerations on anticoagulation reversal: spotlight on the reversal of dabigatran
Abstract
David Giannandrea,1,2,* Anna Mengoni,3,* Erberto Carluccio,3 Giuseppe Ambrosio31Neurology Departement - Stroke Unit, Gubbio/Gualdo Tadino Hospitals, Perugia, Italy; 2Association “Naso Sano”, Umbria Regional Registry of No-Profit Organization, Corciano, Italy; 3Cardiology and Cardiovascular Physiopathology, S. Maria della Misericordia Hospital, USL Umbria 1, Perugia, Italy *These authors contributed equally to this work Abstract: Idarucizumab (Praxbind) is a humanized antibody fragment, that reversibly and with high affinityties up dabigatran (Pradaxa). Anticoagulation reversal is achieved immediately, and with no procoagulant effect. It is administered intravenously and clearance is renal. The main clinical application of idarucizumab is to antagonize bleeding related to dabigatran, especially if it occurs at critical sites, such as nervous system (central or peripheral), intraocular, pericardial, retroperitoneal or pulmonary. Other indications are: i) dabigatran-induced anticoagulation reversal in the need for emergency surgery or procedures at high risk of bleeding; and ii) second-line treatment in bleedings that persist despite local hemostasis procedures. In this narrative review, we comprehensively address clinical indications for idarucizumab, summing up evidence derived from a systematic literature review, but also from case reports.Keywords: dabigatran, idarucizumab, bleeding, surgery
