Matt is a haematology and internal medicine (not in that particular order) advanced trainee, currently working in Wellington.
The First 6 Months Of Dabigatran Reversal In A New Zealand Tertiary Center
Dr M Wheeler, Registrar, Wellington Hospital, New Zealand
Dr A Borrie, Registrar, Wellington Hospital, New Zealand
Prof J Carter, Consultant, Wellington Hospital, New Zealand
Background: Evidence increasingly supports the use of Novel Oral Anticoagulants (NOACs) in preference to warfarin with a 10% lower mortality and approximately 50% lower risk of intracranial haemorrhage or haemorrhagic stroke (1) and shorter stays in the intensive care (2). Idarucizumab has recently been introduced as a reversal agent for dabigatran in major bleedng and emergency surgery.
Aims: This retrospective audit aims to review the incidence of major bleeding or emergency surgery in patients on dabigatran in the Wellington region the frequency that they required idarucizumab and the outcome of episodes.
Methods: A search of the laboratory electronic database was performed for all thrombin times requested at hospitals in the Wellington region in the first 6 months after idarucizumab was available. Clinical records were reviewed to identify patients with bleeding or emergency surgery on dabigatran. Demographic data was collected as well as renal function, dabigatran dosing and management including idarucizumab and resumption of anticoagulation.
Results: 3310 patients had thrombin times performed in the 6 month study period. 80 patients were identified who were on dabigatran and presented with either bleeding or needing emergency surgery. 14 patients received idarucizumab, 11 for bleeding and 3 who required emergency surgery. There were no complications or clinical or laboratory concern of rebound anticoagulation. 50% of patients with fractured neck of femur on dabigatran did not receive idarucizumab and this may have contributed to surgical delay.
Conclusions: The first 6 months of Idarucizumab use in the Wellington region has been safe and effective. Increased awareness of idarucizumab use to allow early surgery may improve patient outcomes.