Title:Dabigatran Reversal with Idarucizumab in an Emergency Lumbar Puncture: A Case Report
VOLUME: 14 ISSUE: 1
Author(s):Ornella Spagnolello*, Federica Letteri, Anne Falcou, Lorena Cipollone, Manuela De Michele, Giuliano Bertazzoni and Danilo Toni
Affiliation:Emergency Department, Policlinico Umberto I Hospital in Rome, “Sapienza University of Rome”, Viale del Policlinico, 155 - 00161 Rome, Human Neuroscience Department, Policlinico Umberto I Hospital in Rome, “Sapienza University of Rome”, Rome, Human Neuroscience Department, Policlinico Umberto I Hospital in Rome, “Sapienza University of Rome”, Rome, Emergency Department, Policlinico Umberto I Hospital in Rome, “Sapienza University of Rome”, Viale del Policlinico, 155 - 00161 Rome, Human Neuroscience Department, Policlinico Umberto I Hospital in Rome, “Sapienza University of Rome”, Rome, Emergency Medicine Department, Policlinico Umberto I Hospital in Rome, “Sapienza University of Rome”, Rome, Emergency Department Stroke Unit, Policlinico Umberto I Hospital in Rome, “Sapienza University of Rome”, Rome
Keywords:Direct oral anticoagulants reversal, idarucizumab, dabigatran, emergency lumbar puncture, urgent invasive procedures,
emergency department.
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.
