Two Dabigatran Fast Reversals in a 4-month Period – a Case Report

INTRODUCTION: Idarucizumab is available for immediate reversal of dabigatran-induced anticoagulation in life-threatening bleeding or urgent surgery in patients with non-valvular atrial fibrillation (nvAF). CASE DESCRIPTION: We report a case of an 85-year-old female treated with dabigatran for nvAF, submitted to two fast reversal procedures with idarucizumab in a 4-month period. In the first emergency episode, the patient was admitted due to a fall-related cerebral haemorrhage and subdural haematoma. There was a fast reversal of the effects of dabigatran after idarucizumab administration, which allowed stoppage of the bleeding and a decrease in intracranial pressure, with full patient recovery. Four months later, the patient revisited the hospital complaining of diffuse abdominal pain while on the same antithrombotic therapy. Physical examination showed signs of peritoneal irritation and the use of idarucizumab to reverse the effects of dabigatran was decided upon to secure normal bleeding conditions before surgery. DISCUSSION: Idarucizumab is an efficient, safe and feasible option for dabigatran-treated nvAF patients, when urgent anticoagulant effect reversal is needed. LEARNING POINTS: Clinical situations requiring urgent reversal of the anticoagulant effects of non-vitamin K antagonist oral anticoagulants are expected to be relatively rare but the existence of antidotes enables the clinical management of these situations. Even in independent urgent circumstances occurring over a short period of time, the repeated use of idarucizumab promptly and safely reverses the dabigatran anticoagulant effect without compromising the patient’s clinical outcome. The development and implementation of specific anticoagulation reversal protocols and better guidance on using baseline coagulation tests are needed to ensure timely and appropriate use of this new therapeutic option.