Idarucizumab, but not procoagulant concentrates, fully restores dabigatran‐altered platelet and fibrin components of hemostasis

BACKGROUND Comparative studies on the restoration of hemostasis with different reversal agents after dabigatran therapy have not been performed. We compared the efficacy and prothrombotic potential of the specific antidote idarucizumab with that of previously recommended non‐specific procoagulant concentrates. STUDY DESIGN AND METHODS We explored the in vitro effects of dabigatran (184 ng/mL) on fibrin and platelet‐aggregate formation onto a damaged vessel under flow conditions (600 s−1). The reversal mechanisms and efficacy of idarucizumab (0.3–3 mg/mL) were compared with that of the non‐specific procoagulant concentrates aPCC (25–75 U/Kg), PCC (70 U/Kg), or rFVIIa (120 μg/Kg). Generation of thrombin and prothrombin fragment (F1 + 2), and thromboelastometry parameters of clot formation were measured. RESULTS Dabigatran caused pronounced reductions in fibrin (87%) and platelet interactions (36%) with damaged vessels (p