When Patients on Blood Thinners Have a Stroke

Idarucizumab may quickly reverse the effects of dabigatran in brain hemorrhage patients

(RxWiki News) Although lifesavers in many cases, anticoagulants can cause dangerous bleeding. Reversing that problem, however, may now be easier than ever before.

A medication called idarucizumab (brand name Praxbind) can neutralize the effects of an anticoagulant called dabigatran (brand name Pradaxa), new research found. This research, which was presented at a conference and has not yet been published, could potentially limit the extent of bleeding in patients with brain hemorrhage.

Praxbind was approved by the US Food and Drug Administration (FDA) in October 2015 as the first reversal agent for Pradaxa.

Anticoagulants, more commonly known as blood thinners, are drugs used to help prevent blood clots. Patients with heart conditions, or those who have had a stroke or blood clot, are often prescribed these drugs.

The downside is an increased risk of bleeding. When that bleeding occurs in the brain, there are very few treatment options. Surgery is often necessary to remove the clot, but that also increases bleeding risk.

Richard A. Bernstein, MD, PhD, led a team that tested idarucizumab as a way to reverse the effects of dabigatran. Dr. Bernstein is a neurologist and the director of the stroke program at Northwestern Memorial Hospital in Chicago.

Dr. Bernstein and team looked at 90 patients, 18 of whom were treated with idarucizumab. These researchers found that two doses of idarucizumab injected in a 15-minute period completely reversed the effects of dabigatran.

"This is definitely good news," Dr. Bernstein said in a press release. "Idarucizumab rapidly and completely reverses the effect of dabigatran in patients with brain hemorrhage. Once the dabigatran is reversed, we can focus on taking care of the patient without worrying about the blood thinner. This reassurance could lead to more strokes prevented by increasing the use of an effective blood thinner."

David J. Scott, PharmD, RPH, told RxWiki News that the biggest potential risk tied to idarucizumab is thrombosis or thromboembolism elsewhere in the body while doctors are trying to stop the brain hemorrhage.

"When dealing with a brain hemorrhage, however, this would be an acceptable risk," Dr. Scott said. "The other risk I foresee is that hospitals will likely not carry a large supply of this 'antidote' due to its rather large price tag."

This ongoing study was presented Feb. 19 at the American Stroke Association's International Stroke Conference 2016. Research presented at conferences may not have been peer-reviewed.

Pharmaceutical company Boehringer Ingelheim funded this research. Praxbind and Pradaxa are both marketed by Boehringer Ingelheim.

All study authors reported receiving funding from Boehringer Ingelheim.

Review Date: 
February 12, 2016