Even though the use of direct oral anticoagulants is rapidly increasing, no antidote for the reversal of dabigatran was available for use in clinical practice so far. Immediate reversal of anticoagulation is essential when facing severe bleeding or emergency surgery. Efficacy and safety in real-life practice will nevertheless require prospective registries monitoring. Idarucizumab successfully reversed the effect of dabigatran in real-life practice in a patient with sepsis and renal impairment and allowed emergency surgery with normal haemostasis. In the absence of postoperative bleeding, dabigatran was restarted 36 hours after admission. Sepsis was controlled after surgery and kidney function remained stable. TT and aPTT time were normalised (16.2 sec, resp., 30.2 sec). Dabigatran concentration was not detectable 10 min after idarucizumab administration (<30 ng/mL). Before immediate emergency surgery dabigatran was antagonised using idarucizumab 2 × 2.5 g. Thrombin time (TT) and activated partial thromboplastin time (aPTT) 15 hours after the last intake of 150 mg dabigatran were both prolonged (>120 sec, resp., 61 sec), as well as unbound dabigatran concentration (119.05 ng/mL). We present the case of a 67-year-old male septic patient with a multilocular facial abscess and chronic kidney disease (GFR 36.5 mL/min). Although idarucizumab is approved for the reversal of dabigatran in many countries, clinical experiences are lacking, particularly in special patient-populations such as sepsis and impaired renal function.
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