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Real World Outcomes Associated with Idarucizumab: Population-Based Retrospective Cohort Study. Am J Cardiovasc Drugs 2020; 20:161-168. [PMID: 31332727 DOI: 10.1007/s40256-019-00360-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Idarucizumab reverses the anticoagulant effect of dabigatran, but few comparative studies have reported on clinical outcomes with idarucizumab. OBJECTIVE Our objective was to determine the effect of idarucizumab on clinical outcomes. METHODS We conducted a retrospective cohort study in a nationally representative sample of hospitals in the United States. The study population included adults ≥ 18 years who were hospitalized for dabigatran-associated major bleeding between January 1, 2015 and December 31, 2017. We compared idarucizumab-exposed patients to the unexposed group. Our primary outcome of interest was in-hospital mortality. RESULTS We included 266 exposed and 1345 non-exposed participants across 271 hospitals. Among participants with gastrointestinal bleeding, there was no statistically significant difference in the odds of in-hospital mortality [9/153 (5.9%) vs 37/1124 (3.3%); adjusted odds ratio = 1.39, 95% confidence interval 0.51-3.45] between the idarucizumab-exposed and non-exposed groups. Among participants with intracranial bleeding, there was an excess of in-hospital mortality [13/112 (11.6%) vs 6/217 (2.8%)] associated with idarucizumab exposure, but limitations include sparse data and the inability to rule out residual confounding or confounding by disease severity. CONCLUSIONS Among a large nationally representative sample of adult patients with dabigatran-associated major bleeding in the United States, we found no difference in in-hospital mortality among patients with gastrointestinal bleeding associated with idarucizumab exposure. An excess risk of in-hospital mortality associated with idarucizumab exposure among participants with intracranial bleeding deserves further exploration.
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Peacock WF, Grotta JC, Steiner T. Idarucizumab for Reversal of Dabigatran in Early/Emergency Surgeries: A Case Series. J Emerg Med 2019; 57:e167-e173. [PMID: 31662218 DOI: 10.1016/j.jemermed.2019.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/26/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Idarucizumab is a humanized, monoclonal antibody fragment used specifically to reverse the anticoagulant effects of dabigatran. CASE REPORTS We discuss 4 cases of patients who were treated with idarucizumab to reverse dabigatran before early/emergency surgery. Two of the patients had subdural hematomas, 1 had a splenic laceration, and 1 had Fournier gangrene. All patients received 5 g of idarucizumab before surgery. Intraoperative blood loss in all patients was normal, no adverse events were reported, and the patients recovered normally. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The case reports presented provide detailed, practical, real-world experience beyond that reported in other case reports and the Reversal Effects of Idarucizumab on Active Dabigatran study. This can help guide clinicians on how idarucizumab can reverse the anticoagulant effect of dabigatran in emergency situations, including patients with subdural hematoma. Our experience suggests that idarucizumab may be a safe and effective antidote to the effects of dabigatran in real-life bleeding situations involving early or emergency surgeries.
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Affiliation(s)
- W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Thorsten Steiner
- Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt am Main, Germany; Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
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Izaguirre Ávila R, Bahena López JE, Cortina de la Rosa E, Hernández Márquez MÁ. Idarucizumab to revert the anticoagulant effect of dabigatran in traumatic acute subdural haematoma: a case report of first use in Latin America. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:5523693. [PMID: 31449648 PMCID: PMC6601192 DOI: 10.1093/ehjcr/ytz098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/13/2018] [Accepted: 05/24/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Direct oral anticoagulants (DOAC) are an attractive alternative over vitamin K antagonists. They have several advantages in primary and secondary prevention of thromboembolisms due to atrial fibrillation, as well as in prevention and treatment of thromboembolic venous disease. They have fast onset action, do not need laboratory controls in patients with normal renal function, and they have practically no interference with the patient's diet or medications. The strongest objection to their use was the lack of reversal agents that could be used in case of life-threatening haemorrhage or the need for emergency surgery. Dabigatran was the first DOAC to have its own specific reversal agent: idarucizumab, a monoclonal antibody. CASE SUMMARY We report here the case of a patient undergoing treatment with dabigatran that suffered an expansive subdural haematoma secondary to a cranial injury. The condition was life-threatening and required emergency surgery. Anticoagulation was successfully reversed with idarucizumab. DISCUSSION Emergency surgery in patients in treatment with DOAC is associated with an increased risk of bleeding. With the use of a specific antidote to block the action of the anticoagulant, as in the case of idarucizumab with dabigatran, the risk of complications during and after emergency surgery is reduced. This is the first case report with which the successful use of idarucizumab in Latin America is documented.
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Affiliation(s)
- Raúl Izaguirre Ávila
- Department of Haematology, National Institute of Cardiology 'Dr Ignacio Chávez', Juan Badiano #1. Col. Sección XVI Del., Tlalpan, Mexico City C.P, Mexico
| | - José Eduardo Bahena López
- Department of Cardiology, National Institute of Cardiology 'Dr Ignacio Chávez', Juan Badiano #1. Col. Sección XVI Del., Tlalpan, Mexico City C.P, Mexico
| | - Evelyn Cortina de la Rosa
- Department of Haematology, National Institute of Cardiology 'Dr Ignacio Chávez', Juan Badiano #1. Col. Sección XVI Del, Tlalpan, Mexico City C.P, Mexico
| | - Miguel Ángel Hernández Márquez
- Department of Cardiology, National Institute of Cardiology 'Dr Ignacio Chávez', Juan Badiano #1. Col. Sección XVI Del., Tlalpan, Mexico City C.P, Mexico
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Gendron N, Gay J, Lemoine M, Gaussem P, Lillo-Le-Louet A, Smadja DM. Usefulness of initial plasma dabigatran concentration to predict rebound after reversal. Haematologica 2018; 103:e226-e229. [PMID: 29472359 DOI: 10.3324/haematol.2017.183400] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Nicolas Gendron
- AP-HP, European Hospital Georges Pompidou, Hematology Department, Paris, France.,Université Paris Descartes, Sorbonne Paris Cite, Paris, France.,Inserm UMR-S1140, Paris, France
| | - Juliette Gay
- AP-HP, European Hospital Georges Pompidou, Hematology Department, Paris, France.,Université Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - Marine Lemoine
- AP-HP, European Hospital Georges Pompidou, Regional Center of Pharmacovigilance, Paris, France
| | - Pascale Gaussem
- AP-HP, European Hospital Georges Pompidou, Hematology Department, Paris, France.,Université Paris Descartes, Sorbonne Paris Cite, Paris, France.,Inserm UMR-S1140, Paris, France
| | - Agnès Lillo-Le-Louet
- AP-HP, European Hospital Georges Pompidou, Regional Center of Pharmacovigilance, Paris, France
| | - David M Smadja
- AP-HP, European Hospital Georges Pompidou, Hematology Department, Paris, France .,Université Paris Descartes, Sorbonne Paris Cite, Paris, France.,Inserm UMR-S1140, Paris, France
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Mourafetis J, Doctor N, Leung S. Treatment of gastrointestinal bleeding with idarucizumab in a patient receiving dabigatran. Am J Health Syst Pharm 2018; 75:177-182. [PMID: 29343478 DOI: 10.2146/ajhp160980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE A case report describing use of idarucizumab for dabigatran reversal without the use of hemostatic agents in a patient who developed acute upper gastrointestinal (GI) bleeding while receiving triple antithrombotic therapy is presented. SUMMARY A 77-year-old man with a complex cardiac history presented to the emergency room with chief complaints of black tarry stools and low blood pressures for 4 days. His past medical history included recent percutaneous coronary intervention (PCI) and drug-eluting stent (DES) placement, atrial fibrillation, hypertension, hyperlipidemia, coronary artery disease, coronary artery bypass graft surgery, stage 3 chronic kidney disease, and cholecystectomy. His triple antithrombotic therapy consisted of aspirin, clopidogrel, and dabigatran. The patient stated that his last dose of dabigatran was taken the night before. Serum dabigatran levels were not measured. Due to suspicion of acute upper GI bleeding, all antithrombotic agents were withheld. Treatment with idarucizumab, i.v. pantoprazole, and blood transfusion was ordered. An upper endoscopy was safely performed 24 hours later and revealed a minor Mallory-Weiss tear. The patient was discharged 48 hours later with prescriptions for acid suppressant and triple antithrombotic therapy; his melena had resolved before discharge. At 14-week follow-up, the patient reported that his cardiologist had deleted aspirin from his antithrombotic regimen. CONCLUSION A patient who had recently undergone PCI and DES placement and was receiving aspirin, clopidogrel, and dabigatran for atrial fibrillation was successfully treated for acute GI bleeding with idarucizumab without the use of a hemostatic agent.
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Dideriksen D, Damkier P, Nybo M. Rivaroxaban non-responders: do plasma measurements have a place? Clin Chem Lab Med 2017; 56:e16-e18. [PMID: 28688225 DOI: 10.1515/cclm-2017-0473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 01/16/2023]
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Ebinger J, Granger CB, Zhu A, Chang A, Henry TD. Idarucizumab since FDA approval: Use in the real-world. Am Heart J 2017; 193:93-94. [PMID: 29129261 DOI: 10.1016/j.ahj.2017.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/11/2017] [Indexed: 12/17/2022]
Affiliation(s)
| | | | - Alexander Zhu
- University of Iowa Carver School of Medicine, Iowa City, IA
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Vornicu O, Larock AS, Dincq AS, Douxfils J, Dogné JM, Mullier F, Lessire S. Idarucizumab for the treatment of hemorrhage and dabigatran reversal in patients requiring urgent surgery or procedures. Expert Opin Biol Ther 2017; 17:1275-1296. [DOI: 10.1080/14712598.2017.1349749] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Ovidiu Vornicu
- Department of Anesthesiology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Anne-Sophie Larock
- Namur Thrombosis and Hemostasis Center (NTHC) – NAmur Research Institute of LIfe Sciences (NARILIS), Namur, Belgium
- Department of Pharmacy, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Anne-Sophie Dincq
- Department of Anesthesiology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
- Namur Thrombosis and Hemostasis Center (NTHC) – NAmur Research Institute of LIfe Sciences (NARILIS), Namur, Belgium
| | - Jonathan Douxfils
- Namur Thrombosis and Hemostasis Center (NTHC) – NAmur Research Institute of LIfe Sciences (NARILIS), Namur, Belgium
- Department of Pharmacy, Faculty of Medicine, Université de Namur, Namur, Belgium
| | - Jean-Michel Dogné
- Namur Thrombosis and Hemostasis Center (NTHC) – NAmur Research Institute of LIfe Sciences (NARILIS), Namur, Belgium
- Department of Pharmacy, Faculty of Medicine, Université de Namur, Namur, Belgium
| | - François Mullier
- Namur Thrombosis and Hemostasis Center (NTHC) – NAmur Research Institute of LIfe Sciences (NARILIS), Namur, Belgium
- Hematology Laboratory, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Sarah Lessire
- Department of Anesthesiology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
- Namur Thrombosis and Hemostasis Center (NTHC) – NAmur Research Institute of LIfe Sciences (NARILIS), Namur, Belgium
- Department of Pharmacy, Faculty of Medicine, Université de Namur, Namur, Belgium
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Anticoagulants: Updates on idarucizumab. Br Dent J 2017; 222:140-141. [DOI: 10.1038/sj.bdj.2017.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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