Hot off the Press!

Today, the New England Journal of Medicine released the full cohort analysis of its RE-VERSE AD study, which prospectively examined the ability of idarucizumab, a humanized monoclonal antibody fragment that binds dabigatran with high affinity, to reverse anticoagulation and achieve hemostasis in patients with uncontrolled bleeding or in patients who needed normal hemostasis for the sake of an urgent surgery or invasive procedure (within 8 hours). The study included 503 patients and demonstrated a median maximum percentage reversal of anticoagulation at 4 hours of 100%.  Median time to cessation of bleeding in patients with uncontrolled bleeding was 2.5 hours. Median time to initiation of procedure in patients who needed normal hemostasis for the sake of urgent surgery or invasive procedure was 1.6 hours. This affirmed that idarucizumab is an effective agent for dabigatran reversal in patients who require hemostasis due to uncontrolled bleeding or need for urgent procedure on dabigatran.

http://www.nejm.org/doi/full/10.1056/NEJMoa1707278#t=abstract

Practical Tips:

-For those at Parkland, there is an an order set for reversal of direct acting oral anticoagulants called “DOAC Bleed Management Protocol”

-For those at Clements University Hospital, there is an analogous order set called “Anticoagulation Reversal Protocol”