In accordance with idarucizumab’s approved indication, enrolled participants were prescribed dabigatran, then presented with uncontrolled or life-threatening bleeding (group A, n = 301) or the need for urgent surgery or procedure (group B, n = 202). The full cohort analysis of this study was published in August 2017. This medicine has been shown to rapidly and completely reverse the anticoagulant effects of dabigatran in the open-label, phase III RE‑VERSal Effects of idarucizumab on Active Dabigatran (RE‑VERSE AD) study.
The outcomes achieved with this specific reversal agent are likely to be of continued interest to treating physicians.Clinical data to support the use of idarucizumab are still limited. Clinical use of idarucizumab should follow the same processes as patient enrollment in this study, which is projected to be completed in 2016. Supported by these interim results, idarucizumab has been approved in the United States and the European Union for use when reversal of the anticoagulant effects of dabigatran is needed for emergency surgery/urgent procedures or in patients with life-threatening or uncontrolled bleeding. In an interim analysis of the first 90 participants, idarucizumab rapidly and completely reversed the anticoagulant activity of dabigatran in 88%-98% of participants, and there were no safety concerns, with no deaths or serious adverse events being attributable to idarucizumab. The effectiveness and safety of 5 g of intravenous idarucizumab is being investigated in a prospective, open-label, single-cohort study in patients with serious bleeding or in those requiring an urgent procedure. Although elective invasive procedures and most bleeding complications in dabigatran-treated patients can be managed by temporarily stopping dabigatran therapy and using supportive measures, there are rare clinical situations that require urgent reversal of the anticoagulant effect of dabigatran. It has demonstrated prompt and durable reversal of the anticoagulant effects of dabigatran in animal studies and phase 1 studies of young, elderly, and renally impaired volunteers. Idarucizumab is a monoclonal antibody fragment specifically targeted to dabigatran.
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