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Journal of Thrombosis and Thrombolysis

, Volume 47, Issue 4, pp 487–494 | Cite as

Clinical experience of idarucizumab use in cases of cardiac tamponade under uninterrupted anticoagulation of dabigatran during catheter ablation of atrial fibrillation

  • Kaoru OkishigeEmail author
  • Yasuteru Yamauchi
  • Yuichi Hanaki
  • Koichi Inoue
  • Nobuaki Tanaka
  • Hirosuke Yamaji
  • Takashi Murakami
  • Mamoru Manita
  • Kazuhiro Tabata
  • Tatsuhiko Ooie
  • Youichi Tatsukawa
  • Hirotsuka Sakai
  • Masaru Yamaki
  • Masato Murakami
  • Takuma Takada
  • Yuki Osaka
  • Yuichi Ono
  • Keita Handa
  • Koji Sugiyama
  • Tomoharu Yoshizawa
  • Hidehira Fukaya
  • Hideki Tashiro
  • Susumu Takase
  • Masahide Harada
  • Eiichi Watanabe
  • Teiichi Yamane
  • Seigo Yamashita
  • Kazutaka Aonuma
Article

Abstract

Anticoagulants are prescribed for prevention of thromboembolic events (TE) of atrial fibrillation (AF), however, their effects have a negative impact on disastrous bleeding outcomes. Idarucizumab was developed to reverse the anticoagulation effects of dabigatran. This study aimed to retrospectively investigate the clinical efficacy and safety of idarucizumab in the setting of progressive emergent bleeding events associated with catheter ablation (CA). Dabigatran is given uninterruptedly as an anticoagulant in patients undergoing CA of AF. The capacity of idarucizumab to reverse the anticoagulant effects of dabigatran in patients with cardiac tamponade associated with CA was examined by measuring the activated partial thromboplastin time (aPTT), active clotting time (ACT), and prothrombin international normalizing ratio (PT-INR). The primary endpoint was effective hemostasis. This analysis included 21 patients receiving idarucizumab, given for restoration of hemostasis. In all 21 patients, hemostasis was restored at a median of 205.6 ± 14.8 min. Normal intraoperative cessation of bleeding was reported in 16 patients, and completion of hemostasis was also ascertained in the remaining four within 5 h. No TEs occurred within 72 h after the idarucizumab administration. Despite a significant reduction in the aPTT and ACT, no significant change was observed in PT-INR after administering idarucizumab. In emergency situations, idarucizumab was able to reverse dabigatran within a relatively short period without any serious adverse events.

Keywords

Idarucizumab Dabigatran Anticoagulation Atrial fibrillation Antidote 

Notes

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kaoru Okishige
    • 1
    Email author
  • Yasuteru Yamauchi
    • 1
  • Yuichi Hanaki
    • 2
  • Koichi Inoue
    • 3
  • Nobuaki Tanaka
    • 3
  • Hirosuke Yamaji
    • 4
  • Takashi Murakami
    • 4
  • Mamoru Manita
    • 5
  • Kazuhiro Tabata
    • 5
  • Tatsuhiko Ooie
    • 6
  • Youichi Tatsukawa
    • 6
  • Hirotsuka Sakai
    • 7
  • Masaru Yamaki
    • 7
  • Masato Murakami
    • 8
  • Takuma Takada
    • 8
  • Yuki Osaka
    • 9
  • Yuichi Ono
    • 9
  • Keita Handa
    • 10
  • Koji Sugiyama
    • 10
  • Tomoharu Yoshizawa
    • 11
  • Hidehira Fukaya
    • 11
  • Hideki Tashiro
    • 12
  • Susumu Takase
    • 12
  • Masahide Harada
    • 13
  • Eiichi Watanabe
    • 13
  • Teiichi Yamane
    • 14
  • Seigo Yamashita
    • 14
  • Kazutaka Aonuma
    • 2
  1. 1.Japan Red Cross Yokohama City Bay HospitalKanagawaJapan
  2. 2.University of Tsukuba School of MedicineIbarakiJapan
  3. 3.Sakurabashi Watanabe HospitalOsakaJapan
  4. 4.Okayama Heart ClinicOkayamaJapan
  5. 5.Naha City HospitalOkinawaJapan
  6. 6.Oita Oka HospitalOitaJapan
  7. 7.Nayoro City General HospitalHokkaidoJapan
  8. 8.Shonan Kamakura General HospitalKanagawaJapan
  9. 9.Ome Municipal General HospitalTokyoJapan
  10. 10.Kashiwa Municipal HospitalChibaJapan
  11. 11.Kitasato University School of MedicineKanagawaJapan
  12. 12.St.Mary’s HospitalFukuokaJapan
  13. 13.Fujita Health University School of MedicineAichiJapan
  14. 14.Jikei University School of MedicineTokyoJapan

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