Two Dabigatran Fast Reversals in a 4-month Period – a Case Report

  • Vítor Fagundes Internal Medicine, Centro Hospitalar do Tâmega e Sousa (CHTS), EPE, Penafiel, Portugal
  • Mari Mesquita Internal Medicine, Centro Hospitalar do Tâmega e Sousa (CHTS), EPE, Penafiel, Portugal


Atrial fibrillation, dabigatran, fast reversal, idarucizumab, urgent procedure


Introduction: Idarucizumab is available for immediate reversal of dabigatran-induced anticoagulation in life-threatening bleeding or urgent surgery in patients with non-valvular atrial fibrillation (nvAF).
Case description: We report a case of an 85-year-old female treated with dabigatran for nvAF, submitted to two fast reversal procedures with idarucizumab in a 4-month period. In the first emergency episode, the patient was admitted due to a fall-related cerebral haemorrhage and subdural haematoma. There was a fast reversal of the effects of dabigatran after idarucizumab administration, which allowed stoppage of the bleeding and a decrease in intracranial pressure, with full patient recovery. Four months later, the patient revisited the hospital complaining of diffuse abdominal pain while on the same antithrombotic therapy. Physical examination showed signs of peritoneal irritation and the use of idarucizumab to reverse the effects of dabigatran was decided upon to secure normal bleeding conditions before surgery.
Discussion: Idarucizumab is an efficient, safe and feasible option for dabigatran-treated nvAF patients, when urgent anticoagulant effect reversal is needed.



  • Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe L, et al; ESC Scientific Document Group. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J 2018;39(16):1330–1393.

  • Milling TJ Jr, Ziebell CM. A review of reversal of oral anticoagulants, old and new, in major bleeding and the need for urgent surgery. Trends Cardiovasc Med 2019;pii:S1050-1738(19)30041-6. Epub 2019 Mar 26.

  • Pollack CV Jr, Reilly PA, van Ryn J, Eikelboom JW, Glund S, Bernstein RA, et al. Idarucizumab for dabigatran reversal - full cohort analysis. N Engl J Med 2017;377(5):431–441.

  • Cortese F, Calculli G, Gesualdo M, Cecere A, Zito A, De Vito F, et al. Idarucizumab: what should we know? Curr Drug Targets 2018;19(1):81–88.

  • Praxbind. Summary of product characteristics. Available from: (accessed 24th September 2019).
  • Published: 2019-12-04

    Issue: Vol 6 No 12 (view)

    Section: Articles

    How to cite:
    Fagundes V, Mesquita M. Two Dabigatran Fast Reversals in a 4-month Period – a Case Report. EJCRIM 2019;6 doi:10.12890/2019_001311.

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