Emergency Open Repair for Ruptured Abdominal Aortic Aneurysm Using Idarucizumab: A Case Report

Background: Idarucizumab is the first specific reversal agent for direct oral anticoagulants. There are only a few reports of the use of idarucizumab. Case presentation: A 67-year-old man was transported to our hospital complaining of lower abdominal discomfort and dyspnea. His medical history included hypertension and atrial fibrillation treated with dabigatran. Upon arrival, he was alert, with pale skin, and cold sweats with hemodynamic instability. The imaging evaluation revealed a 79-mm abdominal aortic aneurysm and retroperitoneal hematoma. He was diagnosed with a ruptured abdominal aortic aneurysm. We immediately administered 5 g of idarucizumab for the reversal of dabigatran anticoagulation, and emergency open repair of the abdominal aortic aneurysm was performed. Normal intraoperative hemostasis was ultimately achieved. He was finally discharged without any neurological deficit, but left hip disarticulation was needed because of left limb ischemia. Conclusion: Although idarucizumab would prove useful for patients with a bleeding tendency due to taking dabigatran, it may promote thrombotic events and further studies to clarify the ideal timing for restarting anticoagulation after the administration of idarucizumab are needed.