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Practical considerations on anticoagulation reversal: spotlight on the reversal of dabigatran

Authors Giannandrea D, Mengoni A, Carluccio E, Ambrosio G

Received 30 January 2019

Accepted for publication 3 May 2019

Published 23 May 2019 Volume 2019:15 Pages 139—142

DOI https://doi.org/10.2147/VHRM.S181806

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Cristina Weinberg

Peer reviewer comments 3

Editor who approved publication: Professor Daniel Duprez


David Giannandrea,1,2,* Anna Mengoni,3,* Erberto Carluccio,3 Giuseppe Ambrosio3

1Neurology Departement - Stroke Unit, Gubbio/Gualdo Tadino Hospitals, Perugia, Italy; 2Association “Naso Sano”, Umbria Regional Registry of No-Profit Organization, Corciano, Italy; 3Cardiology and Cardiovascular Physiopathology, S. Maria della Misericordia Hospital, USL Umbria 1, Perugia, Italy
 
*These authors contributed equally to this work
 
Abstract: Idarucizumab (Praxbind) is a humanized antibody fragment, that reversibly and with high affinityties up dabigatran (Pradaxa). Anticoagulation reversal is achieved immediately, and with no procoagulant effect. It is administered intravenously and clearance is renal. The main clinical application of idarucizumab is to antagonize bleeding related to dabigatran, especially if it occurs at critical sites, such as nervous system (central or peripheral), intraocular, pericardial, retroperitoneal or pulmonary. Other indications are: i) dabigatran-induced anticoagulation reversal in the need for emergency surgery or procedures at high risk of bleeding; and ii) second-line treatment in bleedings that persist despite local hemostasis procedures. In this narrative review, we comprehensively address clinical indications for idarucizumab, summing up evidence derived from a systematic literature review, but also from case reports.

Keywords: dabigatran, idarucizumab, bleeding, surgery

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