Klin Farmakol Farm. 2023;37(2):81-84 | DOI: 10.36290/far.2023.015

Limitations of idarucizumab efficacy in acute renal failure - a case report

Jitka Rychlíčková^{1, 2}, Tomáš Trávníček³, Tereza Jelínková³, Jan Žák⁴

¹ Farmakologický ústav, Lékařská fakulta Masarykova univerzita, Brno

² Mezinárodní centrum klinického výzkumu FN u sv. Anny v Brně

³ Oddělení klinické farmacie, Nemocniční lékárna, FN u sv. Anny v Brně

⁴ I. chirurgická klinika, Lékařská fakulta Masarykova univerzita a FN u sv. Anny v Brně

Idarucizumab, a monoclonal antibody fragment capable of binding dabigatran molecules in a 1 : 1 stoichiometric relationship, is a specific antidote for dabigatran. The dose of idarucizumab was estimated based on observed plasma concentrations of dabigatran to achieve immediate, complete, and sustained reversal of the anticoagulant effect of dabigatran. Currently, a single dose of 5 g intravenously is recommended. However, in certain situations, the capacity of idarucizumab may be exhausted, and dabigatran plasma concentrations may rise again within hours of initial administration. We illustrate one such situation with a patient with acute renal failure, where despite the administration of the second dose of idarucizumab, there was no sustained reversal of the effect of dabigatran. The availability of a specific antidote is an indisputable advantage of dabigatran over other direct anticoagulants. Its use needs to be critically evaluated in view of the limitations of its efficacy. This is especially true in patients with acute renal failure or very high plasma concentrations of dabigatran.

Keywords: dabigatran, idarucizumab, acute renal failure, efficacy, limits.

Accepted: July 10, 2023; Published: July 10, 2023  Show citation