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Real-life experience with the specific reversal agent idarucizumab for the management of emergency situations in dabigatran-treated patients: a series of 11 cases

Non-vitamin K antagonist oral anticoagulants (NOACs) have a favorable benefit-risk profile compared with vitamin K antagonists. However, the lack of specific reversal agents has made the management of some patients receiving long-term treatment with NOACs problematic in emergency situations such as...

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Autores principales: Vosko, Milan R., Bocksrucker, Christof, Drwiła, Rafał, Dulíček, Petr, Hauer, Tomas, Mutzenbach, Johannes, Schlimp, Christoph J., Špinler, David, Wolf, Thomas, Zugwitz, Daša
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5337234/
https://www.ncbi.nlm.nih.gov/pubmed/28210988
http://dx.doi.org/10.1007/s11239-017-1476-2
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author Vosko, Milan R.
Bocksrucker, Christof
Drwiła, Rafał
Dulíček, Petr
Hauer, Tomas
Mutzenbach, Johannes
Schlimp, Christoph J.
Špinler, David
Wolf, Thomas
Zugwitz, Daša
author_facet Vosko, Milan R.
Bocksrucker, Christof
Drwiła, Rafał
Dulíček, Petr
Hauer, Tomas
Mutzenbach, Johannes
Schlimp, Christoph J.
Špinler, David
Wolf, Thomas
Zugwitz, Daša
author_sort Vosko, Milan R.
collection PubMed
description Non-vitamin K antagonist oral anticoagulants (NOACs) have a favorable benefit-risk profile compared with vitamin K antagonists. However, the lack of specific reversal agents has made the management of some patients receiving long-term treatment with NOACs problematic in emergency situations such as major bleeding events or urgent procedures. Idarucizumab, a fully humanized Fab antibody fragment that binds specifically and with high affinity to dabigatran, was recently approved for use in adult patients treated with dabigatran when rapid reversal of its anticoagulant effect is required. Clinical experience with idarucizumab is currently limited. We report 11 real-life clinical cases in which idarucizumab was used after multidisciplinary consultation in a variety of emergency situations including severe postoperative bleeding, emergency high-bleeding-risk surgery (hip/spine surgery and neurosurgery), invasive diagnostic testing (lumbar puncture), intracranial bleeding (pre-pontine subarachnoid hemorrhage and lobar intracerebral hemorrhage) and thrombolysis with recombinant tissue plasminogen activator for acute ischemic stroke. This case series illustrates the role of idarucizumab in improving patient safety in rare emergency situations requiring rapid reversal of the anticoagulant effect of dabigatran, while highlighting the importance of information and education about the availability and appropriate use of this recently approved specific reversal agent.
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spelling pubmed-53372342017-03-17 Real-life experience with the specific reversal agent idarucizumab for the management of emergency situations in dabigatran-treated patients: a series of 11 cases Vosko, Milan R. Bocksrucker, Christof Drwiła, Rafał Dulíček, Petr Hauer, Tomas Mutzenbach, Johannes Schlimp, Christoph J. Špinler, David Wolf, Thomas Zugwitz, Daša J Thromb Thrombolysis Article Non-vitamin K antagonist oral anticoagulants (NOACs) have a favorable benefit-risk profile compared with vitamin K antagonists. However, the lack of specific reversal agents has made the management of some patients receiving long-term treatment with NOACs problematic in emergency situations such as major bleeding events or urgent procedures. Idarucizumab, a fully humanized Fab antibody fragment that binds specifically and with high affinity to dabigatran, was recently approved for use in adult patients treated with dabigatran when rapid reversal of its anticoagulant effect is required. Clinical experience with idarucizumab is currently limited. We report 11 real-life clinical cases in which idarucizumab was used after multidisciplinary consultation in a variety of emergency situations including severe postoperative bleeding, emergency high-bleeding-risk surgery (hip/spine surgery and neurosurgery), invasive diagnostic testing (lumbar puncture), intracranial bleeding (pre-pontine subarachnoid hemorrhage and lobar intracerebral hemorrhage) and thrombolysis with recombinant tissue plasminogen activator for acute ischemic stroke. This case series illustrates the role of idarucizumab in improving patient safety in rare emergency situations requiring rapid reversal of the anticoagulant effect of dabigatran, while highlighting the importance of information and education about the availability and appropriate use of this recently approved specific reversal agent. Springer US 2017-02-16 2017 /pmc/articles/PMC5337234/ /pubmed/28210988 http://dx.doi.org/10.1007/s11239-017-1476-2 Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Article
Vosko, Milan R.
Bocksrucker, Christof
Drwiła, Rafał
Dulíček, Petr
Hauer, Tomas
Mutzenbach, Johannes
Schlimp, Christoph J.
Špinler, David
Wolf, Thomas
Zugwitz, Daša
Real-life experience with the specific reversal agent idarucizumab for the management of emergency situations in dabigatran-treated patients: a series of 11 cases
title Real-life experience with the specific reversal agent idarucizumab for the management of emergency situations in dabigatran-treated patients: a series of 11 cases
title_full Real-life experience with the specific reversal agent idarucizumab for the management of emergency situations in dabigatran-treated patients: a series of 11 cases
title_fullStr Real-life experience with the specific reversal agent idarucizumab for the management of emergency situations in dabigatran-treated patients: a series of 11 cases
title_full_unstemmed Real-life experience with the specific reversal agent idarucizumab for the management of emergency situations in dabigatran-treated patients: a series of 11 cases
title_short Real-life experience with the specific reversal agent idarucizumab for the management of emergency situations in dabigatran-treated patients: a series of 11 cases
title_sort real-life experience with the specific reversal agent idarucizumab for the management of emergency situations in dabigatran-treated patients: a series of 11 cases
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5337234/
https://www.ncbi.nlm.nih.gov/pubmed/28210988
http://dx.doi.org/10.1007/s11239-017-1476-2
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