VPB1018 - Experience with the administration of Idarucizumab as a specific antagonist of Dabigatran in the emergency medicine

Tuesday, July 12, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: Virtual

Presenting Author(s)

Ganipa Ramazanov, PhD

Head of the Department
N.V. Sklifosovsky Research Institute for Emergency Medicine, Public Healthcare Institution of Moscow Healthcare Department
Moscow, Moskva, Russia

Co-Author(s)

Elena Klychnikova, MD

Head of the Scientific clinical and biochemical laboratory
doctor
Moscow, Moskva, Russia
AV

Anna Vyshlova

doctor
N.V. Sklifosovsky Research Institute for Emergency Medicine, Public Healthcare Institution of Moscow Healthcare Department
Moscow, Moskva, Russia
ET

Elizaveta Tazina

Senior Researcher
N.V. Sklifosovsky Research Institute for Emergency Medicine, Public Healthcare Institution of Moscow Healthcare Department
Moscow, Moskva, Russia
LA

Liana Akhmatkhanova

Junior Researche
N.V. Sklifosovsky Research Institute for Emergency Medicine, Public Healthcare Institution of Moscow Healthcare Department
Moscow, Moskva, Russia
DC

Dmitrii Cheboksarov

Senior Researcher
N.V. Sklifosovsky Research Institute for Emergency Medicine, Public Healthcare Institution of Moscow Healthcare Department
Moscow, Moskva, Russia
SP

Sergey Petrikov

Head of the Research Institute for Emergency Medicine
N.V. Sklifosovsky Research Institute for Emergency Medicine, Public Healthcare Institution of Moscow Healthcare Department
Moscow, Moskva, Russia

Background: The patients who are taking Direct oral anticoagulants (DOACs) may develop surgical or trauma emergencies that require prompt and safe neutralization of anticoagulant’s action. A modern anticoagulant should have a specific antagonist which is capable to neutralize the anticoagulant effect in the shortest possible time.

Aims: To investigate the administration of Idarucizumab as a specific antagonist of Dabigatran

Methods: The study included 6 patients with non-valvular atrial fibrillation who received Dabigatran to prevent ischemic stroke (IS) and/or systemic embolism. There was performed a clinical and laboratory safety analysis of Idarucizumab for prothrombotic activity

Results: IS was developed in 3 patients on the background of Dabigatran’s administration that required systemic thrombolytic therapy. Acute surgical pathology – strangulated inguinal hernia – was developed in 1 patient. Another patient suffered a fracture of the left humerus as a result of a fall. And in 1 patient an intracerebral hemorrhage was developed while taking Dabigatran. The median values of hemostasis parameters before the administration of Idarucizumab were the following: Platelet count – 191*109/L (158; 241), APTT–26.2 (21.9; 35.0) sec, Thrombin time (TT) – 27.8 (25.0; 37.7) sec, INR–1.23 (1.12;1.29) and Fibrinogen’s level–2.79 (2.52; 3.69) g/L. Only TT was significantly lower – 16.8 (16.6; 18.1) sec (p < 0.05) – after the administration of Idarucizumab. Other parameters after the administration of Idarucizumab did not differ. None of the patients during the entire period of hospitalization developed clinically significant arterial and venous thrombotic complications. Of the three patients with IS who underwent systemic thrombolytic therapy after the administration of Idarucizumab, 2 patients developed asymptomatic hemorrhagic transformation of the area of cerebral ischemia in the form of type 1 petechial impregnation.

Conclusion(s): It was found that despite the fact that Idarucizumab quickly neutralizes the anticoagulant effect of Dabigatran its administration is not associated with clinical and laboratory manifestations of thrombotic complications.