![]() ![]() 6, 7 Effectiveness in reversal was also demonstrated by regression within normal limits of such quantitative parameters in a few minutes after infusion, performed within 8 h of admission. The prospective cohort study RE-VERSE AD (reversal effects of idarucizumab on active dabigatran) showed that two sequential intravenous infusions of 2.5 g each (a total of 5 g) are able to completely reverse the anticoagulant effect of dabigatran within minutes in 88–98% of patients who had elevated dTT and ECT at baseline. 5 Furthermore, idarucizumab has no anticoagulant or pro-coagulant activity, and has no interaction with platelets. 3 It binds dabigatran with high affinity, about 350 times more than thrombin, 4 and adheres with a ratio of 1:1 to dabigatran and its active metabolites, preventing thrombin inhibition. Idarucizumab is a humanized antibody fragment, approved in Europe and the USA with the name Praxbind® (Boehringer, Ingelheim, Germany), that reverses the anticoagulant effects of dabigatran. 3ĭabigatran is the only new oral non-vitamin K anticoagulant that has had an available antidote (idarucizumab) since October 2015. The dTT with hemoclot method and ECT correlate linearly with dabigatran, up to concentrations of 500 ng/mL. Nevertheless, data on the timing of the last dose are still critical in limited resources settings, and to put laboratory findings into context.ĪPTT does not have a linear response to the dabigatran dose or intensity of its anticoagulation effect, but a normal aPTT will exclude an anticoagulated state while an elevated aPTT will provide qualitative information about the increased risk of bleeding. Two tests are to date available for NOACs: i) a qualitative test (activated partial thromboplastin time (aPTT)), which can quickly be performed in all laboratories and give indications on the patient’s coagulation status and ii) quantitative tests (diluted thrombin time (dTT), and Ecarin clotting time (ECT)) that are used to measure drug plasma concentration by measuring the antithrombin effect however, these are not readily available to most clinicians. When such unfortunate circumstances occur, lab tests have been implemented to define coagulation levels or the plasmatic drug concentration, and help clinicians in timing and management choices. 2 Although data from clinical trials and “real life” suggest that the risk of bleeding at critical sites with dabigatran is lower than that of warfarin, it still remains the most feared complication of dabigatran. About three-quarters of a dabigatran dose is excreted with urine, and the elimination half-life is about 15 h if renal function is normal. It is administered orally and binds and inhibits free and clot-bound thrombin. ![]() It has two main indications: i) stroke prevention in patients with non-valvular atrial fibrillation (NVAF) and ii) prevention and treatment of the venous thromboembolism. NOACs radically changed the clinical routine for both clinicians and patients, with no need for continuous monitoring of coagulation tests, fewer drug–drug interactions, dose adjustment necessary only in few circumstances, and no interactions with food.Īmong NOACs, dabigatran etexilate (Pradaxa) is a reversible, competitive, direct thrombin inhibitor. The advent of non-vitamin K antagonist oral anticoagulants (NOACs) in the clinical practice has provided a treatment more effective and safer than warfarin for primary and secondary prevention of stroke and thromboembolic events in non-valvular atrial fibrillation (AF), as well as for the treatment and prevention of recurrences in patients with venous thromboembolic events (VTE). In the last ten years, there has been a revolution in the treatment of patients who need oral anticoagulants. ![]()
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