PB1178 - Praxbind for reversal of Dabigatran: experience in a tertiary hospital

Background: Praxbind is an antibody fragment that can effectively reverses the anticoagulant effect of Dabigatran in patients with bleeding and facing urgent surgery. The 5 g dose used was planned to reverse the 99 percentile of dabigatran levels, however lower doses can also neutralize dabigatran effectively

Aims: To evaluate the use and effectiveness of Praxbind administered to bleeding and surgical patients at our center and study the effect of Praxbind dose

Methods: A retrospective cohort of consecutive patients treated with Praxbind between 01/ 2016 to 10/2021 for major bleeding or before urgent invasive procedures. Praxbind dose (5 gm - HD, 2.5 gm - LD) and the decision for repeated administration was at the discretion of the treating physician. In some patients dabigatran blood levels was taken immediately before and after (30 min.) administration. Response to treatment was graded as adequate, fair or non-responding

Results: Thirty one patients were included (14 females, median age 82 years). Dabigatran indication was atrial fibrillation in all patients. In 26% of patients (8/31) Praxbind was administered at LD. Median pre Praxbind blood levels were 117ng/ml (IQR 323) while post administration median levels was 1 ng/ml (IQR 2). In 28 patients response to Praxbind was graded adequate. Eight patients died (mainly infection) and a single patient died from GI bleeding. In 34% of patients Dabigatran treatment was resumed pre-discharged

Conclusion(s): In our study cohort lower dose Praxbind seemed to be effective in achieving adequate hemostasis in most of our bleeding and surgical patients. This should be confirmed in further studies