Driesz Lajos, Barabás Éva, Bodócs Ildikó, Szántó Zoltán, Herr György, Bencsik Gábor, Pál László, Borbola József
Jász-Nagykun-Szolnok Megyei Hetényi Géza Kórház-Rendelőintézet Szolnok.
Boehringer Ingelheim RCV GmbH & Co KG Magyarországi Fióktelepe Budapest.
Orv Hetil. 2017 Mar;158(10):387-392. doi: 10.1556/650.2017.30684.
At present, the direct thrombin inhibitor dabigatran is the only one amongst the new direct anticoagulants which has an effective, specific reversal agent. The novel agent idarucizumab is a humanized, monoclonal antibody fragment binds to dabigatran within minutes thereby offers an opportunity to induce a safe, long-lasting reverse of the anticoagulant effects of dabigatran. The authors describe the first use of idarucizumab in Hungary (23. 05. 2016) in an old female patient with non-valvular paroxysmal atrial fibrillation of high stroke risk-score and renal dysfunction who was taking dabigatran (2 x 110 mg/day) when an acute abdomen developed requiring emergency cholecystectomy. Patient received the antidote (idarucizumab 2 x 2.5 g/50 ml iv.) two hours before the surgical intervention, and she did not have any uncontrollable, life-threatening bleeding during the surgery. The high activated partial thromboplastin time relating to anticoagulative influence before the surgery normalized completely after administration of the antidote. Antagonizing dabigatran with idarucizumab was feasible and safe without any side effects. The patient received dabigatran therapy again after her recovery. Orv. Hetil., 2017, 158(10), 387-392.
目前，直接凝血酶抑制剂达比加群是新型直接抗凝剂中唯一拥有有效、特异性逆转剂的药物。新型药物依达赛珠单抗是一种人源化单克隆抗体片段，能在数分钟内与达比加群结合，从而为安全、持久地逆转达比加群的抗凝作用提供了契机。作者描述了依达赛珠单抗在匈牙利的首例应用（2016年5月23日），患者为一名老年女性，患有非瓣膜性阵发性心房颤动，卒中风险评分高且伴有肾功能不全，正在服用达比加群（2×110毫克/天），此时突发急腹症，需要进行急诊胆囊切除术。患者在手术干预前两小时接受了解药（依达赛珠单抗2×2.5克/50毫升静脉注射），手术期间未出现任何无法控制的危及生命的出血情况。术前因抗凝影响而升高的活化部分凝血活酶时间在给予解药后完全恢复正常。用依达赛珠单抗拮抗达比加群是可行且安全的，没有任何副作用。患者康复后再次接受了达比加群治疗。《匈牙利医学周报》，2017年，158(10)，387 - 392。
