Abstract WP118: Laboratory Examinations - Lessons Learned From 120 Cases Treated With Idarucizumab in Germany

Abstract

Recently we have shown that idarucizumab application in acute stroke patients treated with dabigatran improves clinical outcome parameters. In this retrospective series of 120 cases positive effects of dabigatran reversal could be documented regarding mortality and modified Rankin scale in patients with acute hemorrhagic stroke (ICH). At the same time, individuals with acute ischemic stroke (IS) regained eligibiliy for intravenous thrombolysis, thereby improving substantially in NIHSS. Here, we report results on medication and blood parameters from this case series. In acute ICH, 15 of 40 patients were on dabigatran 150mg bid, while 25 took 110mg bid. CrCl was above 50ml/min in all cases while TT upon admission was elevated substantially in almost all cases examined. aPTT was normal in 79.5%. In acute IS, 32 patients received 150 mg, 48 received 110 mg dabigatran bid. The vast majority of patients with ischemic stroke had a CrCl above 50 ml/min. TT was prolonged above 35 seconds in 91.4% of cases while aPTT values were normal in 48.1% of patients. These data underline the necessity to prescribe the appropriate dosage recommended in the prescription protocol to all patients since ICH and IS incidence seems to be dose-independent. Furthermore, global hemostasis parameters like aPTT again prove to be not useful for therapeutic decisions. Finally, inclusion of TT values into emergency laboratory examination in patients with acute stroke under dabigatran is helpful to identify patients with impaired hemostasis potentially benefitting from idarucizumab application.