Idarucizumab in major trauma patients: a single centre real life experience

Introduction Trauma care providers are facing an increasing number of elderly patients on direct oral anticoagulants prior to injury. For dabigatran etexilate (DAB), the specific antagonist idarucizumab (IDA) has been approved since 2015 as a reversal agent. However, only limited data regarding the...

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Bibliographic Details
Published in:European journal of trauma and emergency surgery (Munich : 2007) 2021-04, Vol.47 (2), p.589-595
Main Authors: Oberladstätter, Daniel, Voelckel, Wolfgang, Bruckbauer, Martin, Zipperle, Johannes, Grottke, Oliver, Ziegler, Bernhard, Schöchl, Herbert
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Antagonist drugs
Antibodies, Monoclonal, Humanized - pharmacology
Antibodies, Monoclonal, Humanized - therapeutic use
Anticoagulants
Anticoagulants - therapeutic use
Blood Coagulation
Clinical outcomes
Critical Care Medicine
Dabigatran - pharmacology
Dabigatran - therapeutic use
Drug administration
Emergency medical care
Emergency Medicine
Female
Humans
Intensive
Male
Medicine
Medicine & Public Health
Monoclonal antibodies
Older people
Original Article
Retrospective Studies
Sports Medicine
Surgery
Surgical Orthopedics
Trauma
Trauma centers
Traumatic Surgery
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Summary:Introduction Trauma care providers are facing an increasing number of elderly patients on direct oral anticoagulants prior to injury. For dabigatran etexilate (DAB), the specific antagonist idarucizumab (IDA) has been approved since 2015 as a reversal agent. However, only limited data regarding the use of IDA in trauma patients are available. Methods We performed a retrospective analysis of trauma patients under DAB for whom IDA administration was deemed necessary to reverse DAB’s antithrombotic effect. Results A total of 15 (9 male) patients were treated with IDA during the study period. The mean age was 81 ± 10 years. Intracranial haemorrhage ( n  = 7) and long bone fractures ( n  = 5) were the most common types of injury. Three patients were diagnosed as polytrauma. In all but one patient, atrial fibrillation was the indication for DAB intake. The median dose of IDA was 2.5 g (IQR 2.5–5). IDA administration decreased DAB plasma levels from 112.4 (IQR 73.4–123.4) to 5 (IQR 4–12) ng/mL ( p  = 0.031), thrombin time from 114.8 ± 48.3 to 16.2 ± 0.5 s ( p  
ISSN:1863-9933
1863-9941
DOI:10.1007/s00068-019-01233-y