Cash, MD, FASGE, previous Committee Chair, Saltzman, MD, FASGE, Aasma Shaukat, MD, MPH, FASGE,Īmandeep K. Fisher, MD, MHS, FASGE, Lisa Fonkalsrud, BSN, RN, CGRN, Joo Ha Hwang, MD, PhD, FASGE, Abraham, MD, MSCE, FASGE (invited content expert, ad-hoc member), Prepared by: ASGE STANDARDS OF PRACTICE COMMITTEE 2015 373(6): 511-520.The management of antithrombotic agents for patients Dabigatran (Pradaxa) can be reinitiated 24 hours after administration of idarucizumab, as long as the bleeding has resolved and the patient is hemodynamically stable.No dose adjustment is required in renally impaired patients. Renal impairment does not impact the reversal effect of idarucizumab.In vitro data suggest that the inhibition of dabigatran by idarucizumab is not affected by coagulation factor concentrates.There are no known significant interactions.The safety and effectiveness of repeat treatment with idarucizumab have not been established.Plasma dabigatran concentrations can increase more than 12-24 hours after idarucizumab administration, likely due to re-distribution from the extravascular compartment.Idarucizumab will likely correct aPTT and plasma-dilute thrombin time, but the correlation of lab results with improved outcomes is not established.Monitor for signs/symptoms of clinically relevant bleeding and thromboembolic events.Prior to use, assess the presence of dabigatran using elevated thrombin time as the marker for anticoagulant effect.Life-threatening or uncontrolled bleedingĪ humanized monoclonal antibody fragment that binds dabigatran to neutralize its anticoagulant effects as measured by plasma-dilute thrombin time.No other infusion should be administered in parallel via the same intravenous access.Īpproved for reversal of the anticoagulant effect of dabigatran in the setting of:.The line must be flushed with sterile 0.9% Sodium Chloride Injection, USP solution prior to infusion. A pre-existing intravenous line may be used for administration of idarucizumab.Idarucizumab must be administered within 1 hour after removal from the vials.Infusion of each 2.5gm vial should take no longer than 5-10 minutes the second vial must be administered within 15 minutes of the first vial.
The recommended dose of idarucizumab (Praxibind) is 5 g intravenously, administered in two 2.5gm doses, no more than 15 minutes apart.
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