Reversal by the specific antidote, idarucizumab, of elevated dabigatran exposure in a patient with rectal perforation and paralytic ileus C. Thorborg,

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Reversal by the specific antidote, idarucizumab, of elevated dabigatran exposure in a patient with rectal perforation and paralytic ileus C. Thorborg, E.-P. Horn, H. Mofid, F. Langer British Journal of Anaesthesia Volume 117, Issue 3, Pages 407-409 (September 2016) DOI: 10.1093/bja/aew244 Copyright © 2016 The Author(s) Terms and Conditions

Fig 1 Clinical course and findings on whole blood rotational thrombelastometry (ROTEM®). (a) Clinical course of the patient. Abbreviations are as follows (in alphabetical order): aPTT, activated partial thromboplastin time; CT, computed tomography; dTT, diluted thrombin time (Hemoclot®); eGFR, estimated glomerular filtration rate (according to the Modification of Diet in Renal Disease (MDRD) formula); FFP, fresh frozen plasma; Fib, fibrinogen; Hb, haemoglobin; INR, international normalized ratio; IU, international units; n.a., not applicable; n.d., not determined; PCC, prothrombin complex concentrate; PT, prothrombin time; RBCs, packed red blood cells; TT, thrombin time. (b) ROTEM® analysis performed before and after idarucizumab administration. The upper two traces (ROTEM® 1) were obtained ∼4 h before administration of the dabigatran antidote, whereas the middle two traces (ROTEM® 2) and the lower two traces (ROTEM® 3) were obtained ∼1 and 13 h after idarucizumab infusion, respectively. Whole blood clotting was initiated via the extrinsic, tissue factor-dependent pathway in the EXTEM and via the intrinsic contact pathway in the INTEM assay. Reference ranges for the clotting time (CT) were determined to be as follows: CTEXTEM, 42–74 s; and CTINTEM, 137–246 s.3 British Journal of Anaesthesia 2016 117, 407-409DOI: (10.1093/bja/aew244) Copyright © 2016 The Author(s) Terms and Conditions