Idarucizumab in major trauma patients: a single centre real life experience
Trauma care providers are facing an increasing number of elderly patients on direct oral anticoagulants prior to injury. For dabigatran etexilate (DAB), the specific antagonist idarucizumab (IDA) has been approved since 2015 as a reversal agent. However, only limited data regarding the use of IDA in trauma patients are available.
We performed a retrospective analysis of trauma patients under DAB for whom IDA administration was deemed necessary to reverse DAB’s antithrombotic effect.
A total of 15 (9 male) patients were treated with IDA during the study period. The mean age was 81 ± 10 years. Intracranial haemorrhage (n = 7) and long bone fractures (n = 5) were the most common types of injury. Three patients were diagnosed as polytrauma. In all but one patient, atrial fibrillation was the indication for DAB intake. The median dose of IDA was 2.5 g (IQR 2.5–5). IDA administration decreased DAB plasma levels from 112.4 (IQR 73.4–123.4) to 5 (IQR 4–12) ng/mL (p = 0.031), thrombin time from 114.8 ± 48.3 to 16.2 ± 0.5 s (p < 0.0001) and activated partial thromboplastin time form 45.4 ± 11.3 to 34.2 ± 7.0 s (p = 0.0025). No thromboembolic events or side effects attributed to IDA were observed. All patients survived until hospital discharge.
In trauma patients under DAB prior to injury, IDA decreased DAB plasma levels and normalized coagulation parameters. IDA appears to be safe, and no serious side effects were observed in this small cohort of patients.
KeywordsTrauma Dabigatran Idarucizumab
We would like to thank Lisa Sandner and her team from the Central Laboratory of the AUVA Trauma Centre Salzburg for their ambitiously assistance in running some of the analyses.
Conception and design: D.O., B.Z., and H.S. Data extraction: D.O., M.B. Data analysis: H.S., W.V., O.G., J.Z., D.O. Drafting the manuscript: H.S., D.O., W.V., B.Z. and O.G. All authors critically reviewed the manuscript and agreed to the final version.
This study was funded by hospital resources.
Compliance with ethical standards
Conflict of interest
H. S. has received honoraria for participation in advisory board meetings for Bayer Healthcare, Böhringer Ingelheim and Tem International, and has received study Grants from CSL Behring. O. G. has received study Grants from CSL Behring, Portola, TEM International. B. Z. has received speaker fees from CSL Behring. D. O., J. Z., and M. B. declare no conflict of interest.
- 5.Barnes GD, Lucas E, Alexander GC, Goldberger ZD. National trends in ambulatory oral anticoagulant use. Am J Med. 2015;128(1300–5):e2.Google Scholar
- 17.Vosko MR, Bocksrucker C, Drwiła R, Dulíček P, Hauer T, Mutzenbach J, et al. Real-life experience with the specific reversal agent idarucizumab for the management of emergency situations in dabigatran-treated patients: a series of 11 cases. J Thromb Thrombolysis. 2017;43:306–17.CrossRefGoogle Scholar
- 33.Product information: Idarucizumab. https://www.tga.gov.au/sites/default/files/auspar-idarucizumab-161025-pi.pdf. Accessed 25 Oct 2016.
- 37.Honickel M, Braunschweig T, Rossaint R, Stoppe C, ten Cate H, Grottke O. Reversing dabigatran anticoagulation with prothrombin complex concentrate versus idarucizumab as part of multimodal hemostatic intervention in an animal model of polytrauma. Anesthesiology. 2017;127:852–61.CrossRefGoogle Scholar