To examine the use of idarucizumab via the emergency department at Christchurch Hospital.It is licensed to be given as two consecutive doses of 2.5g, the second dose within 15 minutes of finishing the first dose.2 Each 5g dose of idarucizumab has a PHARMAC listed cost of $4,250. It was included in PHARMAC’s Hospital Medicines List (HML) in June 2016 for the reversal of the anticoagulant effects of dabigatran when required in situations of life-threatening or uncontrolled bleeding, or for emergency surgery or urgent procedures. While a 2g IV dose has been shown to be capable of reversing dabigatran in healthy subjects given 220mg orally twice a day of dabigatran, a 5g dose is used.1 Idarucizumab was first registered in New Zealand in December 2015. Idarucizumab binds dabigatran with an affinity 350 times stronger than dabigatran binds thrombin. It irreversibly binds to dabigatran and has a rapid onset and slow offset. It specifically binds protein bound and unbound dabigatran and its active metabolites to form complexes, thus stopping dabigatran’s anticoagulant effects.
Idarucizumab is a monoclonal antibody fragment that acts as a reversal agent to the direct thrombin inhibitor dabigatran.
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