![]() Glund S, Stangier J, van Ryn J, Schmohl M, Moschetti V, Haazen W, et al. A randomised study in healthy volunteers to investigate the safety, tolerability and pharmacokinetics of idarucizumab, a specific antidote to dabigatran. Glund S, Moschetti V, Norris S, Stangier J, Schmohl M, van Ryn J, et al. Pollack CV Jr, Reilly PA, Eikelboom J, Glund S, Verhamme P, Bernstein RA, et al. Comment on: “Effect of age and renal function on idarucizumab pharmacokinetics and idarucizumab-mediated reversal of dabigatran anticoagulant activity in a randomized, double-blind, crossover phase ib study”. Kamel KS, Chin PK, Doogue MP, Barclay ML. Patients require a second emergency surgery/urgent procedure and have prolonged clotting times. Recurrence of clinically relevant bleeding together with prolonged clotting times or The criteria for the additional dose focus on both the clinical condition of the patient as well as the coagulation status: ![]() Consideration of an additional dose is also proposed in the idarucizumab label. Consequently, a second dose of idarucizumab was allowed in the RE-VERSE AD clinical trial the respective data will be available in the final publication when the trial is complete. Kamel and colleagues, there are certain clinical situations in which a re-occurrence of the anticoagulant effect of dabigatran might be harmful. ![]() Importantly, almost none of these patients were bleeding, suggesting that for these patients the re-elevation was not clinically relevant. A re-occurrence of dabigatran anticoagulation was noted in some patients, mostly 12–24 h after idarucizumab administration. In this timeframe most clinical emergencies are expected to resolve. In RE-VERSE AD (REVERSal Effects of idarucizumab in patients on Active Dabigatran), patients’ coagulation times were determined up to 24 h after idarucizumab administration. Coagulation time measurements are frequently applied as routine measures in clinical emergency settings, and the results can provide important information supporting rational treatment decisions. A 5 g dose of idarucizumab completely neutralizes dabigatran anticoagulation in almost all patients, as demonstrated by coagulation time measurements in dabigatran-treated patients receiving idarucizumab as emergency treatment. ![]()
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