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Anticoagulants

Idarucizumab rapidly reverses dabigatran anticoagulation

Researchers find that idarucizumab effectively counteracts the workings of anticoagulant dabigatran in emergency situations.

Agents that can reverse the effects of oral anticoagulants could improve the risk-benefit profile of thrombosis-prevention therapy through use in situations such as uncontrolled bleeding or a need for emergency surgery.

In a study in The New England Journal of Medicine (online, 11 July 2017), researchers intravenously administered idarucizumab, a monoclonal antibody that binds to and reverses the anticoagulant dabigatran, to 301 dagibatran-treated patients with uncontrolled bleeding and 202 undergoing an urgent procedure[1].

They found that, after four hours, the median maximum reversal of dabigatran was 100% (95% confidence interval, 100 to 100). Uncontrolled bleeding stopped in a median of 2.5 hours and the median time to emergency procedure initiation was 1.6 hours, with 93.4% of these patients having normal perioperative haemostasis. Furthermore, there were no adverse drug-related safety signals in the 503 patients.

The researchers say the results demonstrate that idarucizumab can rapidly reverse dabigatran’s effects in emergency situations but post-marketing surveillance will be needed to further assess its safety.

Citation: Clinical Pharmacist DOI: 10.1211/CP.2017.20203333

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Supplementary images

  • 3D structure of the anticoagulant, dabigatran

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