ESOC 2022 | Idarucizumab reversal of dabigatran in acute ischemic stroke and intracranial hemorrhage

Idarucizumab is licensed for use in adults treated with dabigatran when rapid anticoagulation reversal is required for emergency surgery or in uncontrolled bleeding. The monoclonal antibody binds to dabigatran with high specificity, for immediate reversal of its anticoagulant effects. Senta Frol, MD, PhD, University Medical Centre Ljubljana, Slovenia, discusses the evidence for the use of idarucizumab in patients who suffer an acute ischemic stroke or intracranial hemorrhage (ICH). The RE-VERSE AD study (NCT02104947), published in 2017, showed idarucizumab to rapidly and durably reverse anticoagulation in patients with intracranial bleeding on dabigatran. A systematic review of case reports assessed dabigatran reversal by idarucizumab in patients with acute ischemic stroke who are candidates for intravenous thrombolysis (IVT). Safety and efficacy of IVT in this population was found to be comparable to non-anticoagulated patients. Finally, a systematic review of case reports estimated in-hospital mortality in idarucizumab/dabigatran-treated patients with ICH to be 9.7-11.4%. These data support this therapeutic strategy as safe and effective for stroke patients. This interview took place at European Stroke Organisation Conference 2022 in Lyon, France.