Der Einsatz von Idarucizumab bei intrazerebraler Blutung – Ein Fallbericht

Zusammenfassung

Anamnese und klinischer Befund Aufnahme eines 82-jährigen Patienten mit Verdacht auf zerebrale Blutung nach häuslichem Sturz unter Dauerantikoagulation mit Dabigatran wegen Vorhofflimmern.

Untersuchungen Die kraniale Computertomografie zeigte beidseitige chronische Subduralhämatome mit frischen Blutanteilen eines ausgedehnten, linksseitigen Subduralhämatoms und Mittellinienverlagerung. Die Laboranalyse ergab eine nur mäßig hohe Dabigatran-Konzentration bei durchlaufender Thrombinzeit.

Diagnose Sturzbedingte intrazerebrale Blutung und chronisches Subduralhämatom unter Antikoagulation.

Therapie und Verlauf Präoperative Gabe von Idarucizumab zur Antagonisierung von Dabigatran und neurochirurgische Hämatom-Evakuation mit rückläufiger Mittellinienverlagerung. Heparinisierung und Wiederaufnahme der Dabigatran-Behandlung nach Rehabilitation in klinisch stabilem Verlauf bei neurologisch geringgradigen Residuen.

Abstract

History and clinical findings 82-year old male patient suspected of having cerebral hemorrhage under anticoagulation therapy with Dabigatran due to atrial fibrillation.

Investigations CT scan showed bilateral chronic subdural hematomas with fresh blood in left-subdural hematoma and midline shift. Laboratory analysis shows only a moderately high Dabigatran level but thrombin time was high out of range.

Diagnosis Fall-related intracerebral haemorrhage and subdural hematoma under anticoagulation therapy.

Therapy and course Neurosurgical hematoma evacuation and trepanation after preoperative use of Idarucizumab as an antidote for Dabigatran to stop anticoagulative effects and secure normal bleeding conditions, led to reduced midline shift. We started heparin-based anticoagulation first followed by Dabigatran again in clinical steady state and after rehabilitation with neurologically low-grade residuals.

Schlüsselwörter

Idarucizumab - Dabigatran - Antagonisierung - Antidot - zerebrale Blutung

Key words

idarucizumab - dabigatran - anticoagulation - antidote - cerebral bleeding

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