Abstract Number: PB2061
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » Atrial Fibrillation
Background: Idarucizumab is a monoclonal antibody that effectively reverses coagulation activity of dabigatran, regardless of renal function. However, in patients with renal insufficiency, re-elevation of dabigatran levels may occur within 12 to 24h.
Aims: We performed a case-series study with objective to evaluate the efficacy of idarucizumab and the role of hemodialysis for reversal of dabigatran activity in patients with acute renal insufficiency.
Methods: We are describing case-series of adult patients with acute renal insufficiency that needed urgent reversal of dabigatran treatment. Three patients, two men and a female, age 69, 70 and 71 years, presented in the emergency unit with acute abdomen, severe hemorrhage and need for placement of central venous catheter, respectively. The indication for dabigatran was atrial fibrillation in all patients, and none of them had previous renal insufficiency.
Results: The patient with a need of urgent surgical procedure and patient with active severe gastrointestinal bleeding received idarucizumab in a dose of 2×2.5 mg iv, which enabled laparotomy and endoscopy with local hemostasis in the rectum, respectively. Both procedures were successful without excessive bleeding. However, within 12h from the idarucizumab treatment, bleeding diathesis was observed, and dabigatran concentrations were measured again at supra-therapeutical levels. Hemodialysis effectively reduced the dabigatran levels, and no additional bleeding symptoms occurred. The third patient had indication for an urgent hemodialysis due to acute renal failure. Immediately before placement of the catheter the patient received idarucizumab 2.5 g iv. The procedure went uneventful. Patient continued with everyday hemodialysis and had no bleeding complications.
Conclusions: In patients with re-elevation of dabigatran levels after idarucizumab treatment hemodialysis can be considered as consequential therapy. Initial idarucizumab would provide a safe period for the urgent management of patient, but intensive treatment with repetitive idarucizumab doses can be thus avoided and replaced with hemodyalisis.
To cite this abstract in AMA style:
Boban A, Milos M, Desiree CH, Tomic Mahecic T, Grgic Medic M, Renata Z. The Role of Hemodialysis in Patients with Re-Elevation of Dabigatran Levels After Idarucizumab Treatment: A Case Series [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/the-role-of-hemodialysis-in-patients-with-re-elevation-of-dabigatran-levels-after-idarucizumab-treatment-a-case-series/. Accessed September 21, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/the-role-of-hemodialysis-in-patients-with-re-elevation-of-dabigatran-levels-after-idarucizumab-treatment-a-case-series/