Use of idarucizumab to reverse dabigatran in a case of emergency heart surgery – the Cracow experience

Dabigatran etexilate (dabigatran), a direct, selective and reversible thrombin inhibitor, who is administered as a prodrug, being transformed into an active metabolite upon absorption from the digestive tract. Patients on dabigatran can experience serious perioperative bleeding if the emergency surgery is performed while on anticoagulation. At the end of 2015, idarucizumab, a monoclonal antibody fragment that binds dabigatran with high affinity, was approved for use. The RE-VERSE AD trial (NCT02104947) has shown that idarucizumab is efficacious in dabigatran reversal. The current European Heart Rhythm Association and European Association of Cardio-Thoracic Surgery guidelines recommend idarucizumab use in the setting of severe bleeding, or if an emergency surgery is needed during dabigatran treatment. This report summarizes our clinical experience with idarucizumab in dabigatran-treated patients undergoing emergency cardiac surgery.