1,2ĭespite the fact that direct oral anticoagulants (DOACs) are associated with a significantly lower risk of ICH compared with vitamin K antagonists, ICH nevertheless can occur with DOACs, with elderly persons at particularly higher risk. Idarucizumab is a humanized monoclonal antibody that in 2015 received Food and Drug Administration (FDA) approval for the reversal of the anticoagulant effects of dabigatran in cases of life-threatening bleeding or when emergency surgery is required. Motor system examination revealed mild left-sided hemiparesis (graded at 4/5) with a positive Babinski sign on the left side. Her Glasgow Coma Scale score was 13 of 15 (ie, mild neurologic injury), with no evidence of cranial neuropathies. On neurologic examination, the patient was alert and could obey simple commands but was disoriented to time, place, and person. Her respiratory rate and temperature were normal.Ĭardiac examination revealed an irregularly irregular rhythm, with no carotid bruits. The patient’s blood pressure was elevated at 188/136 mm Hg, and she was tachycardic, with a heart rate of 110 beats/min. On initial evaluation, the patient was found to be responding minimally to verbal commands the patient’s daughter offered most of the history. The woman had a baseline Karnofsky Performance Scale score of 60% (ie, requires occasional assistance but is able to care for most personal needs), and she had a history of diabetes mellitus, hypertension, and nonvalvular atrial fibrillation for which she was taking twice-daily dabigatran, 110 mg. Ī 90-year-old woman presented to the emergency department (ED) with acute-onset altered mental status and left-sided weakness.
Shaath H, Kohli M. Dabigatran reversal with idarucizumab.
Saint Peter’s University Hospital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey Husain Shaath, MD, MRCP, and Maanit Kohli, MD
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