Use of idarucizumab for dabigatran reversal in patients with non-valvular atrial fibrillation undergoing emergency surgical repair of strangulated femoral hernia

Abstract

Non-vitamin-K oral anticoagulants (NOACs) are approved for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) and dabigatran exetilate, a direct thrombin inhibitor, was the first one to be approved. While anticoagulated, patients can experience serious perioperative bleeding so idarucizumab, a specific for dabigatran reversal agent was developed, in order to remove anticoagulant action and restore normal haemostasis. We report a case of a 61-year-old woman with history of NVAF on dabigatran, presented to the emergency department with a strangulated right femoral hernia causing small bowel obstruction, where idarucizumab was administered before surgery. The patient had received her last dose of dabigatran 4 hours before presenting to the emergency department and her activated partial thromboplastin time was over the upper limit of reference. Surgery followed about one hour after the administration of idarucizumab and surgeon reported normal perioperative haemostasis. The patient had a normal recovery, received parenteral anticoagulation until her hospital discharge when she was advised to restart dabigatran. To our knowledge, this is the first case of successful reversal of anticoagulation, with the use of idarucizumab, to a patient in need for an emergency surgery, in Greece.

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