1, 7, 8 Experience with the use of coagulation factors such as prothrombin complex concentrate (PCC) to antagonize dabigatran activity is limited, and its effectiveness has never been studied in clinical trials. 6 Before the availability of idarucizumab, treatment and prevention of severe bleeding in dabigatran-treated patients involved supportive care and nonspecific blood products. 4, 5 In the RE-VERSE AD study (Reversal of Dabigatran Anticoagulant Effect With Idarucizumab), idarucizumab provided rapid, effective, safe, and durable reversal of dabigatran activity in the presence of uncontrollable hemorrhage that warranted immediate reversal or the need for urgent surgery. Idarucizumab (Praxbind) is a humanized monoclonal antibody fragment that binds dabigatran with high affinity, neutralizing its ability to inhibit thrombin. 1 Thus, an agent that can rapidly counteract the anticoagulant effect of dabigatran in these patients would be a valuable tool in severe bleeding management. 3 In patients with nonvalvular atrial fibrillation, the 150-mg twice-daily dose of dabigatran was associated with an increased risk of GI bleeding, and the 110-mg twice-daily dose was comparable to VKAs. 1, 2 Even so, as with all anticoagulants, dabigatran still confers a risk of gastrointestinal (GI) bleeding that in rare cases can lead to hemodynamic instability and result in high risk for morbidity and mortality.
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