OC 65.4 - Idarucizumab for Reversal of Dabigatran: Multicenter Real-World Experience

Tuesday, July 12, 2022

3:30 PM – 3:45 PM

Location: ExCel Center, ICC Capital Suite Room 8&9

Presentation Format: Virtual

Presenting Author(s)

PB

Paola A. Barzallo Burbano, MD

Hematology Resident
Hospital General Universitario Gregorio Marañón, Madrid, Spain
Madrid, Madrid, Spain

Co-Author(s)

CF

Cristina Fernández Maqueda

MD
Hospital Universitario Puerta de Hierro, Madrid, Spain
Madrid, Madrid, Spain
MM

Mar Meijón

MD
Hospital Universitario Ramón y Cajal, Madrid, Spain
Madrid, Madrid, Spain
NR

Nuria Revilla

MD
Department of Hematology, Hospital Universitario Fundación Jiménez Díaz, Instituto Investigación Sanitaria FJD (IIS-FJD) Madrid, Spain.
Madrid, Madrid, Spain
MB

María Jesús Blanco Bañares

MD
Hospital Universitario La Paz, Madrid, Spain
Madrid, Madrid, Spain
BF

Begoña Fernández

MD
Hospital Universitario de Móstoles, Madrid, Spain
Madrid, Madrid, Spain
RR

Ramón Rodríguez González

MD
Hospital Severo Ochoa, Madrid, Spain
Madrid, Madrid, Spain
MS

María Elena Sola Aparicio

MD
Hospital Rey Juan Carlos, Madrid, Spain
Madrid, Madrid, Spain
BR

Belén Rosado Sierra

MD
Hospital Rey Juan Carlos, Madrid, Spain
Madrid, Madrid, Spain
SA

Susana Asenjo

MD
Hospital Clínico San Carlos, Madrid, Spain
Madrid, Madrid, Spain
IG

Isabel Gutiérrez Jomarrón

MD
Hospital Universitario Príncipe de Asturias
Madrid, Madrid, Spain
PP

Pilar Pilar Llamas Sillero

MD
Fundación Jiménez Diaz, Madrid, Spain
Madrid, Madrid, Spain
PP

Pablo Prieto Martínez

Hematology Resident
Hospital Universitario Puerta de Hierro, Madrid, Spain
Madrid, Madrid, Spain
RD

Raquel De Santiago Álvarez

Pharmacy Resident
Hospital Universitario Puerta de Hierro, Madrid, Spain
Madrid, Madrid, Spain
JD

José Luis Díez Martín

Medical Doctor
Deparment of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Madrid, Madrid, Spain
GP

Gloria Pérez Rus

MD
Hospital General Universitario Gregorio Marañón, Madrid, Spain
Madrid, Madrid, Spain
CP

Cristina Pascual Izquierdo

Medical Doctor
Deparment of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Madrid, Madrid, Spain

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.