idarucizumab in the reversal of bleeding with dabigatran

Last reviewed 12/2021

Idarucizumab

• the first targeted antidote of dabigatran, a direct oral anticoagulant used for prevention and treatment of venous thromboembolism and prevention of stroke in atrial fibrillation
  
  
• a humanized fragment of a monoclonal antibody, which binds dabigatran reversibly with high affinity and, when administered intravenously, immediately neutralizes its anticoagulant effect
  
  
• rapidly cleared by the kidney with captured dabigatran
  
  
• licensed for use in adults when rapid reversal of dabigatran etexilate's anticoagulant effects is required for emergency surgery or urgent procedures, or in life-threatening or uncontrolled bleeding. Idarucizumab is likely to be an important treatment option for people with life-threatening bleeding and those who need urgent surgery associated with a bleeding risk
  
  
  • NICE state that ".... The decision on whether to treat people with idarucizumab will need to be made on an individual patient basis, taking into account factors such as the location, size and severity of the bleeding (or the risk of bleeding associated with the surgical intervention or invasive procedure), the thrombotic risk of their underlying disease, and any comorbidities the person has. Standard supportive measures should be considered as medically appropriate...
  • Dabigatran etexilate has a half-life of approximately 12–14 hours in people with normal renal function, but this is increased in people with renal impairment. Therefore the timing of the last dose of dabigatran etexilate is likely to be a factor in whether reversal of its anticoagulant effect is needed.."

Reference:

• NICE (May 2016). Evidence summary: new medicine. Reversal of the anticoagulant effect of dabigatran: idarucizumab