Reversal of dabigatran using idarucizumab: single center experience in four acute stroke patients
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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.
KeywordsStroke Thrombolysis Intracranial hemorrhage Dabigatran Idarucizumab Antidote
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Conflict of interest
Dr. Jochen Brich has received speaker honoraria from Boehringer-Ingelheim und Daiichi Sankyo and travel support from Boehringer-Ingelheim. Prof. Dr. Andreas Harloff has received speaker honoraria from Bayer, Pfizer, Bristol-Myers-Squibb and Boehringer-Ingelheim and participated in a round table meeting organized by Bayer, and the other authors declare that they have no conflict of interest.
Statement of human rights
For this type of study formal consent is not required.
Informed consent was obtained from all individual participants included in the study.