# Idarucizumab Reversal in Subdural Hemorrhage: A Single-Center Experience

## TL;DR

This study examines the use of idarucizumab to reverse dabigatran in elderly patients with subdural hemorrhage, showing it is safe and effective for both surgical and non-surgical management.

## Contribution

The study provides real-world evidence of idarucizumab's effectiveness in reversing dabigatran for subdural hemorrhage in elderly patients.

## Key findings

- Idarucizumab enabled rapid and safe reversal of dabigatran in elderly patients with subdural hemorrhage.
- Most patients underwent surgical evacuation, with moderate functional outcomes and low in-hospital mortality.
- Anticoagulation was resumed in a minority of patients within weeks post-discharge.

## Abstract

Prompt reversal of anticoagulation in the elderly population with subdural hematoma (SDH) is critical to reduce morbidity and facilitate timely surgical intervention. In patients receiving dabigatran, idarucizumab provides rapid anticoagulation reversal. We evaluated clinical and radiological outcomes of dabigatran-treated SDH patients receiving idarucizumab, including those undergoing surgical management. We conducted a single-center retrospective observational study of dabigatran-treated patients who received idarucizumab reversal for traumatic or spontaneous SDH between 2016 and 2024. Hematoma evolution was monitored using follow-up computed tomography. Clinical and neurological outcomes were recorded. Of eleven included patients (mean age 80.8 ± 6.7 years; 36% female), falls were the primary cause (64%). SDH was chronic in 64% and acute in 36%, with associated traumatic lesions in 33%. Surgical evacuation was performed in 82% of cases. Anticoagulation was resumed in 27% of patients within 3–4 weeks post-discharge. The median Glasgow Outcome Scale Extended (GOSE) score was 5, indicating moderate disability. In-hospital mortality was 9.1%. Idarucizumab enabled rapid and safe dabigatran reversal in this high-risk elderly cohort, supporting both surgical and conservative SDH management. Functional outcomes were moderate and mortality was low, underscoring its clinical utility. Targeted reversal strategies remain essential, and further research should refine long-term anticoagulation management.