Abstract

DE SANTIAGO-ALVAREZ, R; HERNANDEZ-TERCIADO, C; DELGADO-TELLEZ-DE CEPEDA, L  and  SANCHEZ-GUERRERO, A. Pharmacokinetics of dabigatran and use of its antidote idarucizumab. Rev. OFIL·ILAPHAR [online]. 2022, vol.32, n.4, pp.411-413.  Epub Oct 23, 2023. ISSN 1699-714X.  https://dx.doi.org/10.4321/s1699-714x20220004000018.

One of the advantages of dabigatran, a new direct-acting oral anticoagulant, is the availability of an antidote to reverse its activity: idarucizumab. This drug is used in emergency surgical procedures or interventions and in life-threatening or uncontrolled bleeding.

Dabigatran has a half-life of 12-14 hours, lengthening if renal function is affected. The decision on when to interrupt the administration depends on the creatinine clearance rate and the bleeding risk of the procedure.

We present the case of a patient on dabigatran treatment who was hospitalized for hip surgery after a fall. On admission, dabigatran was suspended, and surgery was performed on the tenth day after its suspension. Before surgery, it was decided to administer idarucizumab due to continued altered coagulation times.

In this case, it is reported the lack of improvement in clotting times after the use of the antidote, which may be explained by the long period of time between the administration of idarucizumab and the last dose of dabigatran administered (10 days).

Therefore, in case of dabigatran levels cannot be measured, it is important to consider, in addition to clotting times, pharmacological aspects of dabigatran such as pharmacokinetics, in order to avoid unnecessary administration of the antidote, which may entail unnecessary risk and costs.

Keywords : Idarucizumab; dabigatran; antidote; anticoagulants; surgery; coagulation.

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