Clinical Practice and Cases in Emergency Medicine

Dabigatran etexilate mesylate is a direct thrombin inhibitor used for reducing the risk of stroke andsystemic embolism in patients with non-valvular atrial fibrillation. Dabigatran belongs to a new generationof oral agents for anticoagulation – the direct oral anticoagulants (DOACs). The DOACs also includethe factor Xa inhibitors rivaroxaban, apixaban, and edoxaban. In the case of major or life-threateningbleeding and/or the need for emergent invasive procedures, a reversal agent is needed if a patient istaking one of these medications. Research has shown the efficacy of idarucizumab as an antidote inhealthy volunteers, but data in the case of life-threatening bleeds remains limited. We report a caseof a patient who suffered a traumatic subarachnoid hemorrhage and received effective treatment withidarucizumab. Along with other reports, our case demonstrates that dabigatran-related major and/orlife-threatening bleeds may be effectively counteracted by idarucizumab. This provides an option toemergency department providers in managing clinically significant bleeds in patients taking dabigatran.