Abstract Number: PB1121
Meeting: ISTH 2020 Congress
Background: The standard Idarucizumab (Praxbind®, Boehringer-Ingelheim, Germany) dosage is reported to neutralize the activity of 99% of the peak dabigatran values observed in the RE-LY study. However, 5 mgs may be insufficient for some patients.
Aims: To analyze the effectiveness of Idarucizumab in patients with impairment of the renal function.
Methods: Starting 2017, seven patients with NVAF on dabigtran etexilate (2 women and 5 men, 45-91 years old) received the antidote because of either major bleeding (3), severe trauma (3), or emergent surgery. Four patients died in-hospital and two survived.
Results: Serum creatinine, PT ratio, and aPTT ratio ranged from 0.86 to 7.28 mg/dl, 1.72 to 9.92, and 2.07 to 6.81, respectively. Pre-treatment dabigatran plasma levels ranged from 200 to ≥900 ng/ml. In six patients, dabigatran levels in blood collected 5-10 min after idarucizumab infusion were < 10 ng/ml, with normalization of PT and aPTT ratios. Post-antidote dabigatran level was 214 ng/ml in an 88 years-old patient with melena and increasing s-creatinine. Ten hours later, dabigatran level was again >900 ng/ml, and increased to 332 ng/ml 30 hours after an additional standard dose of the antidote. To safely undergo endoscopy, an additional 2.5 mg dose of the antidote was infused.
A 45 years-old patient with acute post-renal failure requiring surgery, had 352 ng/ml plasma dabigatran 24 hours after surgery and 101 ng/ml 4 days after. A 76 years-old patient presented with marked PT and aPTT prolongations and severe melena. Plasma dabigatran was >900 ng/ml one day after antidote administration, decreasing to 715, 442, 204 and 74 ng/ml over a period of 9 days.
Conclusions: Impaired renal function may require higher than standard Idarucizumab dosing. We suggest repeated measurement of plasma dabigatran before and over the days following antidote administration.
To cite this abstract in AMA style:Fattorini A, Pozzi L, Tomassini L, Crippa L, Della Valle P, D'Angelo A. Idarucizumab to Neutralize Dabigatran in a University Hospital: The Relevance of Renal Function [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/idarucizumab-to-neutralize-dabigatran-in-a-university-hospital-the-relevance-of-renal-function/. Accessed January 28, 2022.
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