Reversal of Dabigatran with Idarucizumab in Acute Subarachnoid Hemorrhage

Dabigatran etexilate mesylate is a direct thrombin inhibitor used for reducing the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation. Dabigatran belongs to a new generation of oral agents for anticoagulation – the direct oral anticoagulants (DOACs). The DOACs also include the factor Xa inhibitors rivaroxaban, apixaban, and edoxaban. In the case of major or life-threatening bleeding and/or the need for emergent invasive procedures, a reversal agent is needed if a patient is taking one of these medications. Research has shown the efficacy of idarucizumab as an antidote in healthy volunteers, but data in the case of life-threatening bleeds remains limited. We report a case of a patient who suffered a traumatic subarachnoid hemorrhage and received effective treatment with idarucizumab. Along with other reports, our case demonstrates that dabigatran-related major and/or life-threatening bleeds may be effectively counteracted by idarucizumab. This provides an option to emergency department providers in managing clinically significant bleeds in patients taking dabigatran.