26th July 2019, Volume 132 Number 1499

Louisa J Sowerby, Jane Vella-Brincat

Idarucizumab is a monoclonal antibody fragment that acts as a reversal agent to the direct thrombin inhibitor dabigatran. It specifically binds protein bound and unbound dabigatran and its active metabolites…

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Summary

Idarucizumab is a high-cost medicine used to reverse the anticoagulant (anti-clotting) medicine dabigatran. We examined the use of idarucizumab from the emergency department and via the prescribing programme MedChart™. We looked at why it was being used and compared this to the national guidelines from PHARMAC and our own guidelines in Hospital HealthPathways. From 12 patients who received idarucizumab, all but one patient had idarucizumab prescribed for them according to both PHARMAC and local guidelines. The one exception had been a patient who had accumulated dabigatran in their body so there was high risk for the patient to have a bleed that could not be controlled.

Abstract

Aim

To examine idarucizumab use via the emergency department (ED), Christchurch Hospital; adherence to Hospital Medicines List (HML) criteria, licensed dosing and local coagulation monitoring guidelines.

Method

All patients given idarucizumab were recorded over three months. Data collected included demographics, coagulation tests, dabigatran dosing and timing of idarucizumab administration.

Results

Twelve patients received idarucizumab. The median age (range) was 73 (56–83) years and male:female was 4:8. HML criteria were met in 11 patients. Eleven patents had idarucizumab administered within licence. Coagulation tests were taken pre-idarucizumab in all patients and post-idarucizumab in eight patients. The median thrombin clotting times pre- and post-idarucizumab were 153 and 16 seconds respectively.

Conclusion

The indications for idarucizumab use were within HML criteria and administration was as per licensed dosing regimen in 11 of 12 patients. Appropriate monitoring of coagulation parameters was carried out in all patients as per local guidelines prior to idarucizumab administration, and thrombin clotting times pre and post were as expected for all but one patient.

Author Information

Louisa J Sowerby, Pharmacist, Emergency Department, Christchurch Hospital, Christchurch;
Jane Vella-Brincat, Clinical Pharmacist, Pharmacy Department, Christchurch Hospital, Christchurch.

Acknowledgements

Dr Paul Chin, Clinical Pharmacologist, Christchurch Hospital.

Correspondence

Louisa J Sowerby, Pharmacist, Emergency Department, Christchurch Hospital, Christchurch.

Correspondence Email

louisa.sowerby@cdhb.health.nz

Competing Interests

Nil.

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