Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: Dabigatran reversal
Dabigatran is one of several new generation anticoagulant agents – unlike warfarin (a vitamin K antagonist), dabigatran does not require INR monitor to assess the extent of anticoagulation. Dabigatran has a mode of action that involves prevention of conversion of fibrinogen to fibrin, preventing thrombus formation. Thrombin-induced platelet aggregation is also inhibited.
- In Australia, approved indications for the use of dabigatran include prevention of VTE after joint replacement surgery, the treatment of acute VTE, and the prevention of strokes secondary to non-valvular atrial fibrillation. All of these situations are relatively widespread, meaning that this medication is commonly encountered in the aged care setting.
- Unlike the other direct-acting anticoagulants (apixaban, rivaroxaban), in the event that a need to reverse anticoagulation with dabigatran arises, there is an option that can be used to restore coagulation in the event of serious bleeding complications.
- Idarucizumab is a monoclonal antibody that binds dabigatran with a much higher affinity that observed with thrombin, and thus binds free and thrombin-bound dabigatran and neutralizes its activity. In clinical research, idarucizumab rapidly and completely reversed the anticoagulant effect of dabigatran in up to 98% of the patients with elevated clotting times at baseline.
- In the event of serious GI bleeding or intracranial haemorrhage, prompt referral to a hospital will allow an intervention with idarucizumab that may prove to be life-saving.
Please consider these issues when preparing or interpreting RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to firstname.lastname@example.org.