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Reversal of dabigatran using idarucizumab: single center experience in four acute stroke patients

Maren Hieber1,2, Heiko Hollasch3,4, Dorothee Heck3,4

  • 1Department of Neurology and Clinical Neurophysiology, Medical Center, University of Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany. maren.hieber@uniklinik-freiburg.de.

Journal of Thrombosis and Thrombolysis
|April 11, 2018
PubMed

Dabigatran is a direct thrombin inhibitor and a non-vitamin-K-antagonizing oral anticoagulant, approved for the prevention of stroke and systemic embolization in atrial fibrillation. Idarucizumab is a humanized monoclonal antibody that was recently approved for antagonizing the anticoagulant effects of dabigatran. Here, we report the use of idarucizumab in four acute stroke patients treated with dabigatran in order to enable intravenous thrombolysis in three patients and emergent trepanation in one patient with space occupying subdural hematoma. Since experience on the optimal management of acute stroke patients under medication with dabigatran and on the use of idarucizumab is currently limited, we propose an approach for laboratory testing and fast administration of intravenous thrombolysis and neurosurgery based on our experience.

Keywords:
AntidoteDabigatranIdarucizumabIntracranial hemorrhageStrokeThrombolysis

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