Reversal of the Anticoagulation Effects of Dabigatran Etexilate by Idarucizumab in Three Patients Needing Urgent Surgical Intervention and One Case of Intravenous Thrombolysis in Ischaemic Stroke

OBJECTIVE: To describe the benefits of reversal of the anticoagulation effects of dabigatran etexilate in patients requiring urgent surgery or thrombolysis for ischaemic stroke. MATERIALS AND METHODS: Four patients, treated with dabigatran etexilate and presenting with cholecystitis, tibial fracture, lower limb ischaemia and ischaemic stroke, respectively. RESULTS: Administration of idarucizumab normalized bleeding parameters and provided safe conditions for surgery and, in one case, successful thrombolysis of an ischaemic stroke. CONCLUSION: The introduction of an effective reversal agent for dabigatran etexilate allows physicians perform surgery under conditions of normal coagulation and permits thrombolysis in patients with ischaemic stroke despite being treated with dabigatran etexilate. LEARNING POINTS: Novel oral anticoagulants (NOACs) are a safe alternative to warfarin to prevent ischaemic stroke. Ability to reverse the anticoagulant effects of NOACs could increase adherence to anticoagulation therapy, thereby decreasing the risk of ischaemic stroke. Reversal of the anticoagulant effect of dabigatran etexilate can improve the outcome in patients needing urgent surgery, intervention and thrombolysis.