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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.