• Jerrold H Levy, Joanne van Ryn, Frank W Sellke, Paul A Reilly, Amelie Elsaesser, Stephan Glund, Jörg Kreuzer, Jeffrey I Weitz, and Charles V Pollack.
• Duke University School of Medicine, Durham, NC.
• Ann. Surg. 2021 Sep 1; 274 (3): e204-e211.

ObjectiveTo further examine anticoagulation reversal and clinical outcomes in dabigatran treated patients requiring urgent surgery or procedural interventions.BackgroundIdarucizumab, a humanized monoclonal antibody fragment, reverses dabigatran anticoagulation.MethodsData from surgical and procedural patients in RE-VERSE AD, a multicenter, open-label, single-arm, prospective cohort of dabigatran reversal were evaluated. A total of 202 patients in this group received 5 g of idarucizumab before surgery or procedures.ResultsThe interventions included 49 abdominal, 45 orthopedic, 34 vascular, 8 neurologic, and 4 genitourinary surgical procedures, or 29 catheter-based cases, 20 cases for drainage, and 8 diagnostic procedures. Five patients did not undergo their intended intervention after receiving idarucizumab. Complete reversal of the dabigatran anticoagulant effect occurred within minutes in almost all patients, with normal hemostasis in more than 91% of patients. The median time from the first vial of idarucizumab to surgery or procedures was less than 2 hours in all groups except neurosurgery, where it was 3.3 hours. Fresh frozen plasma and packed red cells were the most frequently transfused blood products. Postreversal thromboembolic events occurred in 10 (5%) patients at 30 days, 5 of whom had restarted anticoagulation before the event. Overall 30-day mortality was 12.6%. There were no serious adverse safety signals due to idarucizumab dosing.ConclusionsIdarucizumab facilitates management of patients requiring urgent procedures by providing rapid dabigatran reversal, and is the only agent of its class studied in surgical patients.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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