Hysterectomy with a double annexectomy was made.12 hours after surgery, anticoagulant treatment with low molecular weight heparin was introduced. Due to the need of urgent surgery, idarazizumab was given in two intravenous boluses of 2.5 g. The last dosis of Dabigatran had been 6 hours ago. The patient was moved over specialized hospital.

Renal function was normal.Īn abdominal/pelvic CT scan was performed, where pneumoperitoneum was observed in an important amount as well as abundant hemoperitoneum, suggesting uterine perforation. Two hours later: PT 23%, INR 3.15, PT 2.7 ratio. Thus, it is administered 10 mgr Konakion and 1200 IU Human Prothrombin Complex. In the previous 24 hours, surgical hysteroscopy had been performed, due to postmenopausal metrorrhagia, in order to rule out the endometrial process.Ĭomplementary tests showed a drop in hemoglobin levels from 14.8 mg/dL to 12.3 g/dL, prothrombin activity 8%,INR 10.58, Prothrombin time (PT) 8%, activated partial thromboplastin time (APTT) 55 seconds. The two clinical cases of patients treated with idarucizumab in this year are described.Ī 70-year-old woman receiving anticoagulant Dabigatran 150mg/12h for Non-valvular Atrial Fibrillation (NVAF), who comes to the emergency due to abdominal pain of several hours of evolution. This is a descriptive study to determine whether darucizumab would be able to reverse the anticoagulant effect of dabigatran in patients who are about to undergo an urgent procedure. The recommended dose is 5 g administered in two intravenous infusions of 2.5 g every 5-10 minutes. It is indicated in adult patients treated with this direct oral anticoagulant when a rapid reversal of its anticoagulant effect is required, for surgical or urgent procedures and in the case of potentially fatal or uncontrolled bleeding. It thus neutralizes its anticoagulant effect. It is a humanized monoclonal antibody fragment (Fab) that binds dabigatran and its metabolites with a very high affinity, approximately 300 times more potent than the binding affinity of dabigatran to thrombin. Idarucizumab is a specific reversal agent for dabigatran. Patients who are receiving oral anticoagulant therapy for the prevention of stroke or thrombosis may benefit from anticoagulant reversal if they present life-threatening bleeding or if they will be undergoing urgent surgery or intervention.

Reversal of pradaxa anticoagulant