Lumbar puncture after direct oral anticoagulant (DOAC) reversal: a proposed algorithm for the emergency department

  • Eugenia RotaEmail author
  • Sergio Agosti
  • Roberta Risso
  • Nicola Morelli

Dear Editor,

The case reported by Spagnolello et al. [ 1] confirms the safety of emergency lumbar puncture after dabigatran reversal with idarucizumab, as suggested by other authors [ 2, 3], including ourselves [ 4] (Table 1). Spagnolello et al. [ 1] re-present the issue of anticoagulant treatment periprocedural management in patients on direct oral anticoagulants (DOACs) requiring lumbar puncture (LP) to rule out infectious diseases of the central nervous system, or subarachnoid hemorrhage.
Table 1

Dabigatran reversal with idarucizumab before lumbar puncture: summary of the cases reported

Patient presentation

Idarucizumab administration

Standard coagulation tests

Clinical outcome

Before idarucizumab administration

After idarucizumab administration

32-year-old female [1]

Reason for administration

Lumbar puncture indicated due to suspicion of infective encephalitis

aPTT: 1 s (normal range 0.8–1.2 s)


Lumbar puncture Performed with no bleeding complication; no other information are reported



The authors thank Barbara Wade for her linguistic advice.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  1. 1.Neurology UnitSan Giacomo HospitalNovi LigureItaly
  2. 2.Cardiology UnitSan Giacomo HospitalNovi LigureItaly
  3. 3.Internal Medicine UnitSanto Spirito HospitalBraItaly
  4. 4.Neurology and Radiology UnitGuglielmo da Saliceto HospitalPiacenzaItaly

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