These case reports indicate that idarucizumab is effective and safe and that it provides rapid reversal of the anticoagulant effect of dabigatran. As patients’ presentations differ from those in the RE-VERSE AD study, further real-world data are needed to understand situations prompting idarucizumab use and to guide management in clinical situations, such as in patients presenting with splenic laceration, Fournier gangrene, and SDH. A set protocol is important for idarucizumab administration so that other members of the health care team in the ED are also aware ( Supplementary Video 3). Real-world evidence on idarucizumab use mainly focuses on patients with acute ischemic stroke, ICH, heart transplantation, and uncontrolled bleeding. Food and Drug Administration and that specifically reverses the anticoagulant effect of dabigatran. Idarucizumab is a humanized, monoclonal antibody that is approved by the U.S. A CT scan on May 5 showed a minimal residual SDH. On April 16, the patient had a left burr hole placed.
A CT scan on April 7th showed a 13-mm left SDH, with a 5-mm left-to-right shift. The headache persisted, more on the left. The patient was in normal sinus rhythm, and no further antithrombotic medications were given. After the patient was stable and the clot was allowed to organize and liquefy, on March 26th right frontal and right parietal burr holes were placed to drain the blood. This resulted in normalization of the coagulation parameters measured at 4:45 am, such as a shortening of the PTT to 31.8 s. About 6 hours later, the patient received 2.5 g idarucizumab intravenously at 1:11 am hours, which was repeated at 1:24 am on March 24th, with the intent of reversing dabigatran's effect and preventing any further enlargement of the SDH. The patient's Glasgow Coma Scale score in the ED at 7:40 pm was 15, and his National Institutes of Health Stroke Scale score was 0.
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