Peacock W Frank, Grotta James C, Steiner Thorsten
Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas.
Memorial Hermann Hospital, Houston, Texas.
J Emerg Med. 2019 Dec;57(6):e167-e173. doi: 10.1016/j.jemermed.2019.09.038. Epub 2019 Oct 26.
Idarucizumab is a humanized, monoclonal antibody fragment used specifically to reverse the anticoagulant effects of dabigatran.
We discuss 4 cases of patients who were treated with idarucizumab to reverse dabigatran before early/emergency surgery. Two of the patients had subdural hematomas, 1 had a splenic laceration, and 1 had Fournier gangrene. All patients received 5 g of idarucizumab before surgery. Intraoperative blood loss in all patients was normal, no adverse events were reported, and the patients recovered normally. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The case reports presented provide detailed, practical, real-world experience beyond that reported in other case reports and the Reversal Effects of Idarucizumab on Active Dabigatran study. This can help guide clinicians on how idarucizumab can reverse the anticoagulant effect of dabigatran in emergency situations, including patients with subdural hematoma. Our experience suggests that idarucizumab may be a safe and effective antidote to the effects of dabigatran in real-life bleeding situations involving early or emergency surgeries.
依达赛珠单抗是一种人源化单克隆抗体片段，专门用于逆转达比加群的抗凝作用。
我们讨论了4例在早期/急诊手术前接受依达赛珠单抗治疗以逆转达比加群作用的患者。其中2例患者患有硬膜下血肿，1例有脾破裂，1例有福尼尔坏疽。所有患者在手术前均接受了5克依达赛珠单抗。所有患者术中失血量正常，未报告不良事件，患者均正常康复。急诊医生为何应了解此事？：所呈现的病例报告提供了比其他病例报告及依达赛珠单抗对活性达比加群的逆转作用研究中所报告的更为详细、实用的真实世界经验。这有助于指导临床医生了解依达赛珠单抗在紧急情况下如何逆转达比加群的抗凝作用，包括硬膜下血肿患者。我们的经验表明，在涉及早期或急诊手术的实际出血情况下，依达赛珠单抗可能是一种安全有效的达比加群效应解毒剂。
