PB0999 - Idarucizumab Reversal Delays: A multicentre retrospective cohort study

Background: Idarucizumab is an effective reversal agent for dabigatran in patients who require haemostasis in the emergency setting. Dabigatran drug concentrations can help guide reversal strategies. The time taken for dabigatran level testing and idarucizumab administration within our local health district (LHD) is unknown.

Aims: To determine what improvements can be made in dabigatran reversal process for acute medical events.

Methods: Ethics approval was granted by our local research ethics committee. Idarucizumab dispensing records from our LHD (comprising of 5 hospitals with over 2000 beds) were used to identify patients who may have received idarucizumab between 2015 and 2023. The electronic medical record and blood bank record were accessed to ascertain the clinical and laboratory data.

Results: From 123 idarucizumab dispensing encounters, 93 events had insufficient electronic data for analysis leaving 30 dispensing events equating to 30 patients to be included in the analysis. The average age was 80 years. 93% of patients were using dabigatran for stroke prevention in atrial fibrillation. 23 (77%) patients presented with haemorrhage, 6 patients presented with surgical pathology requiring emergency surgery and 1 patient presented with ischemic stroke requiring thrombolysis. Of the patients with haemorrhage, 11 (37%) patients had intracranial haemorrhage and 10 (33%) patients had gastro-intestinal haemorrhage. The median door to dabigatran pathology order time was 298 minutes. The median dabigatran concentration order to verification time was 226 minutes and the median door to needle time for idarucizumab was 520 minutes. 9 (30%) patients who had received idarucizumab had subtherapeutic dabigatran concentrations and 24 (80%) patients had received idarucizumab before the dabigatran concentration. One patient died of bleeding related complications.

Conclusion(s): This real-world evidence study has shown that our time metrics for dabigatran concentration testing and idarucizumab delivery require improvement. Further study is needed to elucidate the cause of the significant time delays.