Idarucizumab for dabigatran reversal in the patient with subarachnoid hemorrhage

Abstract

Dabigatran, a well-known direct oral anticoagulant (DOAC), is commonly used, because dabigatran does not require laboratory monitoring, and has lower risk of bleeding than warfarin. However, major bleeding such as intracranial hemorrhage is still a critical cause of concern for patients on dabigatran therapy. We present the case of a 76-year-old female patient with subarachnoid hemorrhage (SAH) and intracerebral bleeding who was taking dabigatran daily for atrial fibrillation. She presented with loss of consciousness and was eventually diagnosed with SAH and intracerebral bleeding. We treated the patient with an antidote, idarucizumab, for dabigatran reversal after which she underwent emergency craniotomy. No bleeding events occurred during the operative and postoperative phase. Non-elective surgery in patients on DOACs requires adequate preoperative preparations because of the increased risk of hemorrhage. Development of the new antidotes will improve perioperative safety for patients taking DOACs.