Praxbind (idarucizumab) / Boehringer Ingelheim - LARVOL DELTA

Tailoring Anesthesia for Cardiac Amyloidosis: A Case Report Highlighting Perioperative Challenges. (PubMed, Cureus) - "Anticoagulation was reversed with idarucizumab, and perioperative hemodynamic instability was managed with vasopressors and dynamic fluid responsiveness assessment. Furthermore, the authors highlight the perioperative hematologic, metabolic, and electrolyte disorders that may arise from disease and cardiac-target therapies such as tafamidis and sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors). We emphasize the importance of individualized planning, multidisciplinary coordination, and vigilant perioperative monitoring to optimize outcomes in this high-risk population."

Journal • Amyloidosis • Anesthesia • Atrial Fibrillation • Cardiac Amyloidosis • Cardiomyopathy • Cardiovascular • Chronic Kidney Disease • CNS Disorders • Depression • Heart Failure • Hematological Disorders • Movement Disorders • Musculoskeletal Diseases • Nephrology • Orthopedics • Parkinson's Disease • Psychiatry • Renal Disease

Specific reversal agents for direct oral anticoagulants in neurosurgical emergencies - a systematic review. (PubMed, Res Pract Thromb Haemost) - "Idarucizumab and andexanet alfa are approved reversal agents, yet their effectiveness and safety in neurosurgical emergencies remain unclear. The use of DOAC reversal agents in emergency neurosurgery appears feasible and may support surgical hemostasis in selected patients. However, further research is warranted, particularly regarding the off-label use of andexanet, given the limited evidence and potential safety concerns."

Journal • Review • Cardiovascular

A UK-wide analysis of 2265 patients receiving a reversal agent for direct oral anticoagulant-associated bleeding. (PubMed, J Thromb Haemost) - "Reversal agents were generally used in patients with clinical evidence of major bleeding but were administered long after the last anticoagulant dose. In gastrointestinal bleeding, andexanet alfa was associated with a higher thrombotic risk than PCC."

Journal • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Gastroenterology • Hematological Disorders • Thrombosis

Dabigatran-idarucizumab pharmacokinetics-pharmacodynamics in sheep undergoing cardiopulmonary bypass. (PubMed, Perfusion) - "A competitive interaction model adequately described dabigatran reversal by idarucizumab. These data and consequent parameter estimates inform future clinical studies in both animals and humans."

Journal • PK/PD data

Emergency Reversal of Antithrombotics in Intracerebral Hemorrhage: An Update. (PubMed, Curr Neurol Neurosci Rep) - "Current data suggests reversal of vitamin K antagonists with intravenous vitamin K and 4-factor prothrombin complex concentrates (4f-PCC), reversal of dabigatran with idarucizumab, and reversal or direct oral factor Xa inhibitors with either 4f-PCC or andexanet-alfa. While platelet transfusion is not suggested for antiplatelet-associated ICH, DDAVP may be reasonable, and a new reversal agent is under development for ticagrelor. Rapid reversal of antithrombotic-associated coagulopathy in the context of ICH may prevent ICH expansion and improve neurological outcomes."

Journal • Review • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders

Rapido: Results from a UK-Wide Audit of 2477 Patients Who Received a Reversal Agent for a Direct Oral Anticoagulant (ASH 2024) - "Although a specific reversal agent for dabigatran, idarucizumab, was approved for use in the UK in 2016, the predominant option for patients taking apixaban, edoxaban, and rivaroxaban has until recently been off-licence prothrombin complex concentrate (PCC). Importantly, the data highlight delays in identification and treatment of bleeds. Further, detailed analysis of this rich dataset is on-going, and a propensity score-matched analysis of patients with GI hemorrhage will be performed to compare outcomes in patients treated with andexanet alfa, Beriplex and Octaplex."

Clinical • Atrial Fibrillation • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Venous Thromboembolism

Recent intake of direct oral anticoagulants and acute ischemic stroke: real world data from a comprehensive stroke center. (PubMed, Neurol Res Pract) - "A considerable proportion of AIS patients with recent DOAC intake exhibited minimal or no anticoagulant activity at presentation. Those with the lowest levels also showed highest stroke severity. IVT was safe across all DOAC level groups, with low and comparable sICH rates. These findings support the rationale for a randomized trial evaluating IVT without prior DOAC level testing."

Journal • Real-world evidence • Cardiovascular • Cerebral Hemorrhage • Hematological Disorders • Ischemic stroke

Idarucizumab Reversal in Subdural Hemorrhage: A Single-Center Experience. (PubMed, Life (Basel)) - "In patients receiving dabigatran, idarucizumab provides rapid anticoagulation reversal. Functional outcomes were moderate and mortality was low, underscoring its clinical utility. Targeted reversal strategies remain essential, and further research should refine long-term anticoagulation management."

Journal • CNS Disorders • Hematological Disorders

DABIGATRAN-BASED ANTICOAGULATION STRATEGY AMONG PATIENTS AWAITING LUNG TRANSPLANT: A SINGLE-CENTER EXPERIENCE (CHEST 2025) - "The median age was 65 (IQR 21.5) years, 9 (60%) were men, 12 (80%) had underlying restrictive lung disease, 11 (73.3%) had a history of pulmonary embolism or deep vein thrombosis, and 1 (6.7%) had concurrent aspirin use. Despite dabigatran reversal with idarucizumab, anticoagulated LTCs remain at significant risk for intraoperative bleeding, hemodynamic instability, and delayed chest closure. Delayed chest closure may be associated with a longer duration of mechanical ventilation, ICU LOS, and hospital LOS. Importantly, this cohort includes patients who underwent prior chest surgery, which increases bleeding risk, therefore the impact of dabigatran remains uncertain."

Clinical • Atrial Fibrillation • Cardiovascular • Hematological Disorders • Pulmonary Disease • Respiratory Diseases • Transplantation

Latin America Multidisciplinary Consensus Panel on Management of Severe Bleeding in the Anticoagulated Patient. (PubMed, J Emerg Med) - "This review highlights the significance of appropriate risk stratification and management strategies for bleeding complications associated with anticoagulants. The manuscript emphasizes the need for adaptable management strategies in regions like Latin America, where resource limitations may impact the availability of specific reversal agents."

Journal • Hematological Disorders

Interference with immunofixation in a dabigatran-overdosed patient treated with idarucizumab: beware of a diagnostic pitfall. (PubMed, Clin Chem Lab Med) - No abstract available

Journal

Prothrombin Complex Concentrate in Direct Oral Anticoagulant Reversal: A Systematic Scoping Review. (PubMed, J Emerg Med) - "Further high-quality studies are essential to deepen understanding regarding PCC effectiveness and safety in achieving clinical hemostasis. However, this review provides the information regarding PCC as an option when DOAC-specific reversal agents are unavailable, or the type of DOAC is unknown."

Journal • Atrial Fibrillation • Cardiovascular • Hematological Disorders • Venous Thromboembolism

Intravenous Thrombolysis in Patients With Recent Intake of Direct Oral Anticoagulants: A Target Trial Analysis and Comparison With Reversal Agent Use. (PubMed, Stroke) - "In addition, a comparison was made with patients from the New Zealand stroke registry, all of whom underwent reversal with idarucizumab...This target trial confirms previous observational data regarding the safety of off-label IVT in patients with recent DOAC intake. More data and dedicated trials are needed for patients with confirmed high DOAC plasma levels and regarding the efficacy and safety of DOAC reversal before IVT."

Journal • Atrial Fibrillation • Cardiovascular • Cerebral Hemorrhage • Hematological Disorders

Cost-effectiveness of dabigatran for thromboembolic events prevention in atrial fibrillation patients in Chile. (PubMed, Cost Eff Resour Alloc) - "Dabigatran is cost-effective and dominates both rivaroxaban and apixaban at current publicly available prices in Chile. In addition, we expect dabigatran-idarucizumab is also expected to be cost-effective for Chilean health system when is compared against acenocoumarol-PCC as reversal agents."

HEOR • Journal • Atrial Fibrillation • Cardiovascular • Hematological Disorders

Management of emergencies in direct oral anticoagulant-treated patients: practice pearls (PubMed, Orv Hetil) - No abstract available

Journal • Review

Idarucizumab more effectively reverses the anticoagulant effects of dabigatran acylglucuronide than dabigatran. (PubMed, Sci Rep) - "Consistently, TGA showed stronger neutralization of dabigatran acylglucuronide, with IC50 values for Cmax, endogenous thrombin potential, and lag time at least 2.0-fold higher than those of dabigatran. These findings indicate that idarucizumab exerts a more potent reversal effect on dabigatran acylglucuronide compared to dabigatran."

Journal

Thrombosis and Coagulopathy. (PubMed, Neurosurg Clin N Am) - "A systematic review from January 1984 to August 2024 highlights a growing preference for prothrombin complex concentrate (PCC) as the primary reversal agent, with limited evidence on idarucizumab for dabigatran. The lack of large clinical trials remains a significant gap, limiting the development of standardized protocols. Increasing use of viscoelastic assays for assessing residual anticoagulant activity offers potential for more personalized treatment strategies."

Journal • Review • Cardiovascular • CNS Disorders • Hematological Disorders • Orthopedics • Thrombosis • Vascular Neurology

Insights from an anticoagulant-related major bleeding registry: review of care practices (ISTH 2025) - "Patients who received one of the following antidotes for bleeding were identified using prescription lists: prothrombin complex concentrate (PCC), andexanet alfa or idarucizumab. During these consultations, a statement of discussion on management of modifiable risk factors for rebleeding was recorded in 31 (59%). Table or Figure Upload"

Review • Cardiovascular • Venous Thromboembolism

Diagnostics and management of direct oral anticoagulants-induced bleeding. (PubMed, Curr Opin Anaesthesiol) - "Clinicians should assess the overall risk of bleeding for an acute procedure or the severity of any ongoing hemorrhage in DOAC-treated patients before initiating any reversal treatment, regardless of current evidence levels."

Journal • Anesthesia • Cerebral Hemorrhage • Hematological Disorders

Transfusion and mortality within 24 hours after major trauma in patients with direct-acting oral anticoagulants (Euroanaesthesia 2025) - "DOACs have gradually replaced warfarin due to favorable efficacy and safety profiles...Only one such agent (idarucizumab for dabigatran) is used in Sweden, while administration of andexanet alfa (for reversal of apixaban, edoxaban and rivaroxaban) is not endorsed by national recommendations since proof of benefit has not been presented compared to administration of prothrombin complex concentrate.The aims were to analyze if patients treated with DOACs presenting with major trauma were more likely to receive blood transfusions, and if they had a higher mortality rate within the first 24 hours after hospital admission, compared to patients with no anticoagulant medication.Materials and This was a single-center, retrospective study...Mortality within 24 hours was observed in 6/47 (13%) patients in the DOAC group compared to 17/222 (8%) in the matched non-DOAC group, OR 1.69 (95% CI 0.62 to 4.58). Erythrocytes transfusion was required in 18 (38%) patients among the cases..."

Clinical • Anesthesia

Sonorheometry parameters during dabigatran reversal with idarucizumab for major bleeding. (PubMed, J Pharmacol Exp Ther) - "SIGNIFICANCE STATEMENT: This study highlights viscoelastic hemostatic assays using the Quantra analyzer to monitor reversal therapy in dabigatran-treated patients with major bleeding. It demonstrates the efficacy of idarucizumab in restoring coagulation parameters, offering insights into clinical management."

Clinical • Journal • Cardiovascular • Gastroenterology • Hematological Disorders • Thrombosis

RECENT INTAKE OF DIRECT ORAL ANTICOAGULANTS AND ACUTE ISCHEMIC STROKE: REAL WORLD DATA FROM A COMPREHENSIVE STROKE CENTER (ESOC 2025) - "In patients with anti-factor IIa/Xa activity >100 ng/ml, IVT was performed in 4% (9), with prior administration of idarucizumab in more than half of the cases...The high prevalence of insufficient anticoagulation in AIS patients despite reported recent DOAC intake highlights potential gaps in therapy adherence and pharmacokinetics. The low incidence of bleeding complications, even in adequately anticoagulated patients undergoing IVT, underscores the importance of tailored acute stroke management."

Clinical • Real-world • Real-world evidence • Cardiovascular • Ischemic stroke

FREQUENCY AND OUTCOME EFFECTS OF ANTAGONIZING ANTICOAGULANT-RELATED INTRACEREBRAL HAEMORRHAGE: REAL-LIFE DATA FROM THE AUSTRIAN STROKE UNIT REGISTRY. (ESOC 2025) - "Of those, 197 (55.3%; VKA), 189 (40.6%; apixaban), 57 (49.6%; dabigatran), 64 (26.0%; edoxaban), and 72 (25.2%; rivaroxaban) received antagonization therapies, respectively. Specific antidots were used in 89 (10.9 %; andexanet alpha) and in 57 (7.0%; idarucizumab) patients... In anticoagulation-related ICH antagonization therapies showed a trend towards reduced odds of END and were significantly associated with improved functional outcomes and reduced mortality."

Clinical • Cardiovascular

2025 Guidelines for direct oral anticoagulants: a practical guidance on the prescription, laboratory testing, peri-operative and bleeding management. (PubMed, Intern Med J) - "Direct oral anticoagulants (DOACs) are widely prescribed to prevent and treat venous and arterial thromboembolism, supported by published evidence, and are preferred over warfarin in many guidelines...The anticoagulant effects of DOACs can be reversed with specific agents, such as andexanet for apixaban and rivaroxaban and idarucizumab for dabigatran. If not available, pro-haemostatic agents such as prothrombin complex concentrates or activated prothrombin complex concentrates can be considered. DOACs can be interrupted and resumed for procedures without the need for 'bridging' with LMWH."

Journal • Cardiovascular • Cerebral Hemorrhage • Gastroenterology

Intravenous Dabigatran Provides Effective, Reversible Anticoagulation for Cardiopulmonary Bypass in a Sheep Model. (PubMed, Anesthesiology) - "Four out of 6 sheep survived 24 hours after the administration of protamine. This study demonstrates that dabigatran effectively provides anticoagulation in a sheep CPB model, and idarucizumab successfully reverses its effects."

Journal • Thrombosis • IL6