LLSA 2020 - Review 10: Idarucizumab for the Reversal of Dabigatran

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Review 10: Idarucizumab for the Reversal of Dabigatran


Kaushal H. Shah, MD
Vice Chair of Education, NYP-Weill Cornell Department of Emergency Medicine, New York, NY
Arjun Prabhu, MD, MBE
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY

About this Review

This “best available evidence” review identified and summarized the 5 original research articles that have directly addressed the efficacy and safety of idarucizumab for dabigatran reversal in humans. While these studies of idarucizumab demonstrated decreased circulating dabigatran levels, improved bleeding parameters, improved hemostasis, decreased bleeding during emergency procedures, and a low rate of drug-related adverse events, several limitations of the available literature minimize clinical application at this time. Limitations include the lack of patient-centered study outcomes data, the fact that there was pharmaceutical company funding for all available studies, and the high cost of the medication, at $3500 per single package in the United States.

Thus, the authors conclude that emergency clinicians should address bleeding in patients taking dabigatran by addressing the specific cause of bleeding and holding further administration of dabigatran rather than using idarucizumab. They do, however, recommend consideration of idarucizumab as part of the reversal strategy for life-threatening cases of bleeding for patients taking dabigatran and for those who need emergency surgery.

  1. Article Citation
  2. Synopsis
  3. Quick Quiz
  4. Discussion
    1. Glund, Moschetti, Norris, et al (Thrombosis and Haemostasis, 2015)
    2. Glund, Stangier, Schmohl, et al (Lancet, 2015)
    3. Glund, Stangier, van Ryn, et al (Clinical Pharmacokinetics, 2017)
    4. Glund, Stangier, van Ryn, et al (Journal of the American College of Cardiology, 2016)
    5. Pollack, Reilly, Eikelboom, et al (The New England Journal of Medicine, 2015)
    6. Limitations of the Studies
  5. Critique
  6. Editor’s Note
  7. Key Points
  8. Additional Reading
  9. Quick Quiz Answers
  10. Original Article

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