Abstract Number: PB2040
Meeting: ISTH 2020 Congress
Background: Dabigatran is the only DOA with a commercial reversor agent, which is Idarucizumab. It allows a quick and safe reversal of the anticoagulant effect. In the REVERSE-AD study, where its effect and safety were studied, 1.8% of patients required a second dose, all of them with decreased GFR. 51 of 91 patients (46.0%) with severe renal impairment had re-elevation of dabigatran levels to 20 ng/ml at either 12 or 24 h.
Potential explanations for re-elevation include delayed redistribution of the drug resulting in saturation of idarucizumab in patients with higher baseline levels of dabigatran, or progressive degradation of the dabigatran-idarucizumab complex in patients with impaired renal function, with corresponding release of dabigatran.
Aims: This study aims to analyze the relationship between dabigatran levels and acute renal failure with the need for a second dose of reversing agent.
Methods: We present the cases of three patients from our center with dabigatran treatment for atrial fibrillation that required a reversal of the anticoagulant effect. We track the evolution of their renal function, dabigatran levels and hemostatic parameters in relation of the administration of Idarucizumab. (Example: Case 3 )
Results: In all the cases, acute renal insufficiency was observed and the levels of dabigatran reappeared after a successful initial reversion. All of them needed a new reversal dose for bleeding persistence.
Conclusions: Dabigatran allows a quick and safe reversal of the anticoagulant effect. But these cases alert us of the recurrence of levels of dabigatran more than 12 hours after the administration of Idarucizumab (5 days after in the last case) in patients with severe renal impairment and initial levels of Dabigatran >1000 (ng/ml). Therefore, more studies are needed to assess the relationship of acute renal insufficiency in the accumulation of dabigatran and its role in the reversal effect with Idarucizumab which its physiopathology isn’t clear.
|Hours since the beginning||Dabigatran levels (ng/ml)||INR||aPTT||Creatinine levels|
To cite this abstract in AMA style:Tugues Peiró A, Marzo Alonzo C, Vicente Pascual E, Ferrero Campos A, Ruiz A, Rivero ME, Garcia Guiñon A, Luaña A, Chavez C, Teixido M, Gomez X, Garcia T. Clinical Case: Reversal of Dabigatran Levels in Patients with Renal Insufficiency that Have Required the use of Idarucizumab [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/clinical-case-reversal-of-dabigatran-levels-in-patients-with-renal-insufficiency-that-have-required-the-use-of-idarucizumab/. Accessed January 23, 2022.
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