Abstract Number: OC 65.4
Meeting: ISTH 2022 Congress
Background: Idarucizumab is a humanized monoclonal antibody that binds to dabigatran and reverses its anticoagulant activity. It´s indicated for imminent surgery and life-threatening bleeding.
Aims: Describe the current experience with idarucizumab in different centers in Madrid.
Methods: Patients with prescription of idarucizumab between June 2016 and October 2021 were included. Qualitative data are presented as frequencies and percentages. Quantitative data are presented as mean or median. Cumulative survival was calculated in a 30-day post-infusion period.
Results: A total of 101 patients from 10 hospitals in Madrid were included. Ninety-seven percent received dabigatran for prevention of embolism in nonvalvular atrial fibrillation and 3% received it for the treatment of thromboembolic disease. The mean age was 72.5 ± 14.6, and 58.4% were men.
The main indication for idarucizumab was reversal of anticoagulation for surgery (46.5%), followed by persistent bleeding (44.5%). The most common type of procedure was cardiac surgery, heart transplantation was a common indication (20/28). Gastrointestinal bleeding was the most common type of bleeding, followed by intracranial bleeding.
The median time between infusion of idarucizumab and cessation of bleeding or onset of surgery was 3 hours. No reports of excessive bleeding during surgery or after fibrinolysis were noted. One patient with dabigatran intoxication had melenas. A case of auricular thrombosis occurred in a patient with a heart transplant.
Full 30-day follow-up was available for 98 patients, during this period 14 died. Cumulative survival after a follow-up period of 30 days was 85% (Figure 1). Seventy-one percent resumed anticoagulation after a median of 4 days, 58.3% were bridged with low molecular weight heparin and 63.4% resumed anticoagulation at discharge.
Conclusion(s): Idarucizumab is effective for the reversal of dabigatran anticoagulation. It was used safely in patients awaiting a heart transplant. No cases of bleeding after infusion or during surgery were reported, except for a case of auricular thrombosis.
To cite this abstract in AMA style:Barzallo Burbano P, Fernández Maqueda C, Meijón M, Revilla N, Blanco Bañares M, Fernández B, Rodríguez González R, Sola Aparicio M, Rosado Sierra B, Asenjo S, Gutiérrez Jomarrón I, Pilar Llamas Sillero P, Prieto Martínez P, De Santiago Álvarez R, Díez Martín J, Pérez Rus G, Pascual Izquierdo C. Idarucizumab for Reversal of Dabigatran: Multicenter Real-World Experience [abstract]. https://abstracts.isth.org/abstract/idarucizumab-for-reversal-of-dabigatran-multicenter-real-world-experience/. Accessed September 29, 2023.
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