Clemens Küpper1, Katharina Feil2,3, Matthias Klein2, Regina Feuerecker2, Marc Lücking4, Florian Thanbichler4, Dennis Dietrich5, Irene Zerkaulen6,7, Mitja Jandl8, Martin Marziniak8, Holger Poppert9,10, Silke Wunderlich9, Helge Topka4, Marianne Dieterich2,3,11, Lars Kellert2. 1. Department of Neurology, Ludwig Maximilians University, Campus Großhadern, Marchioninistraße 15, 81377, Munich, Germany. Clemens.Kuepper@med.uni-muenchen.de. 2. Department of Neurology, Ludwig Maximilians University, Campus Großhadern, Marchioninistraße 15, 81377, Munich, Germany. 3. German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany. 4. Department of Neurology Bogenhausen, Munich Hospital, Munich, Germany. 5. Department of Neurology Harlaching, Munich Hospital, Munich, Germany. 6. Department of Neurology, Helios Hospital Munich West, Munich, Germany. 7. Department of Neurology, Helios Amper Hospital Dachau, Dachau/Munich, Germany. 8. Department of Neurology, Kbo-Isar-Amper-Hospital Munich East, Munich, Germany. 9. Department of Neurology, University Hospital rechts der Isar, Technical University, Munich, Germany. 10. Department of Neurology, Helios Dr. Horst Schmidt Hospitals, Wiesbaden, Germany. 11. Munich Cluster of Systems Neurology (SyNergy), Munich, Germany.
Abstract
OBJECTIVES: To evaluate daily life management and functional outcome of Idarucizumab administration in case of emergency situations in patients with Dabigatran treatment. DESIGN: Multicenter observational registry study. SETTING: All hospitals with full neurological departments (n = 6) in Munich, Germany INCLUDED PATIENTS: All patients treated with Idarucizumab from 01/2016 to 03/2019. ANALYZED DATA: Indication and application of Idarucizumab, demographics and clinical parameters, and further interventions and treatments; clinical outcome was assessed with the modified Rankin scale (mRS) at 3 months after Idarucizumab administration RESULTS: Idarucizumab was administered to 32 patients for severe bleeding complications and ischemic strokes, more precisely for the following specific indications: intracranial bleeding (17 patients, 53%), ischemic stroke (8 patients, 25%), gastrointestinal bleeding (3 patients, 9%), femoral fracture, aortic dissection, and abdominal trauma and ileus (1 patient each, 3%). Additional coagulation management was performed in 7 patients (22%). Nine patients (28%) underwent emergency surgery. Seven patients (22%) received Idarucizumab before intravenous thrombolysis due to ischemic stroke and 4 of these 7 patients (13%) received mechanical thrombectomy in addition. Indication was mainly based on the history of Dabigatran intake and was irrespective of laboratory testing. At follow-up, 25% of the investigated patients had a mRS 0-2, while 25% had an unfavorable outcome (mRS 4-5). Mortality was 31%. CONCLUSION: In our study, we have shown that the administration of Idarucizumab is a rare intervention and restricted to patients with severe bleeding complications or ischemic stroke. The clinical outcome of patients who received Idarucizumab in emergency situations was poor.
OBJECTIVES: To evaluate daily life management and functional outcome of Idarucizumab administration in case of emergency situations in patients with Dabigatran treatment. DESIGN: Multicenter observational registry study. SETTING: All hospitals with full neurological departments (n = 6) in Munich, Germany INCLUDED PATIENTS: All patients treated with Idarucizumab from 01/2016 to 03/2019. ANALYZED DATA: Indication and application of Idarucizumab, demographics and clinical parameters, and further interventions and treatments; clinical outcome was assessed with the modified Rankin scale (mRS) at 3 months after Idarucizumab administration RESULTS:Idarucizumab was administered to 32 patients for severe bleeding complications and ischemic strokes, more precisely for the following specific indications: intracranial bleeding (17 patients, 53%), ischemic stroke (8 patients, 25%), gastrointestinal bleeding (3 patients, 9%), femoral fracture, aortic dissection, and abdominal trauma and ileus (1 patient each, 3%). Additional coagulation management was performed in 7 patients (22%). Nine patients (28%) underwent emergency surgery. Seven patients (22%) received Idarucizumab before intravenous thrombolysis due to ischemic stroke and 4 of these 7 patients (13%) received mechanical thrombectomy in addition. Indication was mainly based on the history of Dabigatran intake and was irrespective of laboratory testing. At follow-up, 25% of the investigated patients had a mRS 0-2, while 25% had an unfavorable outcome (mRS 4-5). Mortality was 31%. CONCLUSION: In our study, we have shown that the administration of Idarucizumab is a rare intervention and restricted to patients with severe bleeding complications or ischemic stroke. The clinical outcome of patients who received Idarucizumab in emergency situations was poor.
Authors: Charles V Pollack; Paul A Reilly; Joanne van Ryn; John W Eikelboom; Stephan Glund; Richard A Bernstein; Robert Dubiel; Menno V Huisman; Elaine M Hylek; Chak-Wah Kam; Pieter W Kamphuisen; Jörg Kreuzer; Jerrold H Levy; Gordon Royle; Frank W Sellke; Joachim Stangier; Thorsten Steiner; Peter Verhamme; Bushi Wang; Laura Young; Jeffrey I Weitz Journal: N Engl J Med Date: 2017-07-11 Impact factor: 91.245
Authors: Pawel Kermer; Christoph C Eschenfelder; Hans-Christoph Diener; Martin Grond; Yasser Abdalla; Katharina Althaus; Jörg Berrouschot; Hakan Cangür; Michael Daffertshofer; Sebastian Edelbusch; Klaus Gröschel; Claus G Haase; Andreas Harloff; Valentin Held; Andreas Kauert; Peter Kraft; Arne Lenz; Wolfgang Müllges; Mark Obermann; Someieh Partowi; Jan Purrucker; Peter A Ringleb; Joachim Röther; Raluca Rossi; Niklas Schäfer; Andreas Schneider; Ramona Schuppner; Rüdiger J Seitz; Kristina Szabo; Robert Wruck Journal: Int J Stroke Date: 2017-03-24 Impact factor: 5.266
Authors: Daniel Šaňák; Stanislava Jakubíček; David Černík; Roman Herzig; Zdeněk Kunáš; Robert Mikulík; Svatopluk Ostrý; Michal Reif; Vladimír Rohan; Aleš Tomek; Tomáš Veverka Journal: J Stroke Cerebrovasc Dis Date: 2018-05-25 Impact factor: 2.136
Authors: Stuart J Connolly; Michael D Ezekowitz; Salim Yusuf; John Eikelboom; Jonas Oldgren; Amit Parekh; Janice Pogue; Paul A Reilly; Ellison Themeles; Jeanne Varrone; Susan Wang; Marco Alings; Denis Xavier; Jun Zhu; Rafael Diaz; Basil S Lewis; Harald Darius; Hans-Christoph Diener; Campbell D Joyner; Lars Wallentin Journal: N Engl J Med Date: 2009-08-30 Impact factor: 91.245
Authors: Sam Schulman; Ajay K Kakkar; Samuel Z Goldhaber; Sebastian Schellong; Henry Eriksson; Patrick Mismetti; Anita Vedel Christiansen; Jeffrey Friedman; Florence Le Maulf; Nuala Peter; Clive Kearon Journal: Circulation Date: 2013-12-16 Impact factor: 29.690
Authors: Sake J van der Wall; Nienke van Rein; Bart van den Bemt; Marieke J H A Kruip; Karina Meijer; Liane C J Te Boome; Tim A Simmers; A Marco W Alings; Robert Tieleman; Frederikus A Klok; Menno V Huisman; Peter E Westerweel Journal: Europace Date: 2019-03-01 Impact factor: 5.214
Authors: Xiaoxi Yao; Neena S Abraham; Lindsey R Sangaralingham; M Fernanda Bellolio; Robert D McBane; Nilay D Shah; Peter A Noseworthy Journal: J Am Heart Assoc Date: 2016-06-13 Impact factor: 5.501
Authors: Juri Sromicki; Mathias Van Hemelrijck; Martin O Schmiady; Bernard Krüger; Mohammed Morjan; Dominique Bettex; Paul R Vogt; Thierry P Carrel; Carlos-A Mestres Journal: Interact Cardiovasc Thorac Surg Date: 2022-06-15
Authors: Duncan Wilson; Teddy Y Wu; David J Seiffge; Thomas Meinel; Jan Christoph Purrucker; Johannes Kaesmacher; Urs Fischer Journal: J Neurol Neurosurg Psychiatry Date: 2021-02-04 Impact factor: 10.154