Persistent Life-Threatening Hemorrhage after Administration of Idarucizumab

• Published in: The American journal of emergency medicine Vol. 35; no. 1; pp. 193.e3 - 193.e5
• Main Authors: Alhashem, Hussain M., MBBS, Avendano, Carmen, MD, Hayes, Bryan D., PharmD, Winters, Michael E., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2017; Elsevier Limited
• Subjects: Aged; Antibodies, Monoclonal, Humanized - therapeutic use; Anticoagulants; Antidotes - therapeutic use; Antithrombins - adverse effects; Atrial Fibrillation - drug therapy; Cardiac arrhythmia; Cardiovascular disease; Dabigatran - adverse effects; Drug dosages; Duodenal Diseases - chemically induced; Duodenal Diseases - therapy; Embolisms; Embolization, Therapeutic; Emergency; Emergency medical care; Gastrointestinal Hemorrhage - chemically induced; Gastrointestinal Hemorrhage - therapy; Heart rate; Hemorrhage; Homeostasis; Hospitals; Humans; Intensive care; Laboratories; Male; Medical imaging; Patients; Treatment Failure; United States > US
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2016.06.096

Repeat measurement of TT 1 hour after the administration of idarucizumab demonstrated a significant reduction to 20.4 seconds (Table). Because of the patient's moribund state, he was intubated and underwent emergent esophagogastroduodenoscopy (EGD) in the ED at hour 3 of his ED stay (Figure). [...]idarucizumab successfully decreased TT to slightly above the upper limit of normal immediately after administration but did not lead to timely hemostasis of the source of the bleeding. Because of the failure of the initial therapy, the patient continued to be hemodynamically unstable, requiring multiple blood transfusions, administration of FEIBA, and emergent angiography with coiling.