• Nina Vene, Alenka Mavri, Mojca Božič-Mijovski, Minja Gregorič, Katja K Uštar, Urša Žerjav, Primož Gradišek, Adela Stecher, Senta Frol, Viljenka Nedog, Nataliya Detkova, and Iwona E Kosi.
• From the Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana (NV, AM, MB-M), Department of Plastic and Reconstructive Surgery, University Medical Centre Maribor, Maribor (MG), Department of Anaesthesiology and Reanimation, Trbovlje General Hospital, Trbovlje (KKU), Department of Anaesthesiology, Celje General Hospital, Celje (UŽ), Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana (PG, AS), Division of Neurology, University Medical Centre Ljubljana, Ljubljana (SF), Department of Cardiology and Angiology, University Medical Centre Maribor, Maribor (VN), General Hospital, Dr. Franca Derganca Nova Gorica, Šempeter pri Gorici (ND) and Department of Neurology, Celje General Hospital, Celje, Slovenia (IEK).
• Eur J Anaesthesiol. 2020 Oct 1; 37 (10): 874-878.

BackgroundReal-life experience with idarucizumab, which reverses the anticoagulant effect of dabigatran, is currently limited.ObjectiveTo evaluate efficacy and safety of the clinical use of idarucizumab after its availability in Slovenia.MethodsWe analysed consecutive cases treated with idarucizumab in Slovenia from January to October 2016. The decision to reverse dabigatran with idarucizumab was made by the treating clinicians, as was the assessment of clinical outcomes and blood sampling/monitoring (activated partial thromboplastin time, thrombin time and diluted thrombin time) before and after use.ResultsIdarucizumab was used in 17 cases. One patient was treated with the antidote twice with an interval of 2 months between treatments. The indications for idarucizumab use were: emergency surgery (4/17), severe bleeding (11/17; seven with intracranial bleeding) and ischaemic stroke (2/17). During surgery, no excessive bleeding was reported. Five patients died due to cardiogenic, haemorrhagic or septic shock, intracranial bleeding or multiple organ failure. Among cases with laboratory data available, baseline coagulation tests were prolonged in 12/13 cases with bleeding or emergency surgery. After idarucizumab administration, normal coagulation parameters were confirmed in 10/11. However, re-occurrence of dabigatran effect was noted later in four patients with creatinine clearance less than 30 ml min, and one patient with persistent bleeding required retreatment with idarucizumab.ConclusionOur first experiences with idarucizumab use in daily-care settings support a rapid and efficient decrease in the anticoagulant effect of dabigatran in emergency situations. Late re-occurrence of dabigatran effect was noted in a subset of patients with severe renal failure.

10 keywords...

hide…