Idarucizumab is here, it works, it’s safe. In the January 2018 EM:RAP, the paper chase segment gave us a fairly uncritical look at the one big study “supporting” the use of idarucizumab. But in this instance, I think that they were both wrong. Walter Himmel, who is one of the smartest individuals I have ever had the opportunity to meet. On EM Cases, the statements were made by Dr. EM:RAP has been irreplaceable in my emergency medicine education. I have incredible respect for these sources. This month I was distressed to hear overly-optimistic, unscientific statements about idarucizumab on two of my favourite emergency medicine education programs: EM:RAP and EM Cases. As physicians, we cannot afford optimism blindness. Optimism, however, can cloud also cloud our judgement allow us to focus only on the good, not the bad. When facing an onslaught of critically ill patients, optimism allows emergency physicians to persist. Few things are as powerful as hope for the future. So far, the lack of specific reversal agents has likely been a factor in the limited uptake of the novel oral anticoagulants (NOACs), given the potential for uncontrolled bleeding.Optimism is essential. It is specifically designed to reverse the anticoagulant activity of both direct and indirect Factor Xa inhibitors. Idarucizumab is indicated for patients treated with dabigatran when rapid reversal of its anticoagulant effects is required for emergency surgery/urgent procedures or in life-threatening or uncontrolled bleeding, the TGA says.Īnother reversal agent for NOACs was shown to be effective in a study in the NEJM last November, but is behind idarucizumab in the approval process.Īndexanet alfa is a recombinant protein designed to reverse the anticoagulant effect in patients treated with oral or injectable Factor Xa inhibitors. The drug is not available on the PBS and will cost around $3,000 per course. The drug is given intravenously as two consecutive infusions over five to ten minutes, or as a bolus injection, according to the TGA, and is now available in Australian hospitals. It will not reverse the effect of other newer anticoagulants, such as rivaroxaban and apixaban. Idarucizumab, (Praxbind), is a monoclonal antibody that reverses the anticoagulant effect by binding specifically to dabigatran (Pradaxa). The first reversal agent for the novel oral anticoagulant dabigatran has been approved by the TGA
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