Dabigatran Reversal with Idarucizumab in an Emergency Lumbar Puncture: A Case Report

Author(s): Ornella Spagnolello*, Federica Letteri, Anne Falcou, Lorena Cipollone, Manuela De Michele, Giuliano Bertazzoni, Danilo Toni.

Journal Name: Current Drug Safety

Volume 14 , Issue 1 , 2019

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Abstract:

Introduction: The widespread use of direct oral anticoagulants (DOACs) has been increasing the conditions in which emergency physicians are forced to rapidly reverse anticoagulation in case of life-threatening bleeding or need of urgent surgery or invasive procedures.

The recent approval of Idarucizumab, a humanized monoclonal antibody fragment (Fab), offered the opportunity to rapidly and safely neutralize the anticoagulant effect of Dabigatran. However, real-world experience of its effective use in different emergency setting is now required. Lumbar Puncture (LP) is recognized as an invasive procedure at major bleeding risk and is, therefore, contraindicated in anticoagulated patients.

Conclusion: We report a successful use of Idarucizumab in an emergency LP of a young woman with a possible diagnosis of encephalitis and a previous history of venous thromboembolism on long-term treatment with Dabigatran 150 mg twice a day.

Keywords: Direct oral anticoagulants reversal, idarucizumab, dabigatran, emergency lumbar puncture, urgent invasive procedures, emergency department.

[1]
Pollack CV, Reilly PA, Eikelboom J, et al. Idarucizumab for dabigatran reversal. N Engl J Med 2015; 373: 511-20.
[2]
Pollack CV, Reilly PA, van Ryn J, et al. Idarucizumab for dabigatran reversal - full cohort analysis. N Engl J Med 2017; 377: 431-41.
[3]
Braemswig TM, Eschenfelder CC, Nolte CH. Emergency LP in a patient receiving dabigatran after antagonization with idarucizumab. Am J Emerg Med 2017; 35(4): 662.
[4]
Samuelson BT, Cuker A, Siegal DM, et al. Laboratory assessment of the anticoagulant activity of direct oral anticoagulants: A systematic review. Chest 2017; 151: 127-38.


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Article Details

VOLUME: 14
ISSUE: 1
Year: 2019
Page: [40 - 42]
Pages: 3
DOI: 10.2174/1574886313666180816125234
Price: $58

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