Idarucizumab for Dabigatran Reversal — EECC MCQ

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EasyCardiac PharmacologyIdarucizumab for Dabigatran ReversalEECC

A 72-year-old man on dabigatran 150 mg bd for AF develops acute GI bleeding requiring endoscopy. His last dose of dabigatran was 2 hours ago. What is the specific reversal agent?

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Reveal the answer and explanation

Correct answer: C — Idarucizumab — a monoclonal antibody fragment that binds dabigatran with high affinity, providing immediate and complete reversal within minutes

Idarucizumab (Praxbind) is a humanised monoclonal antibody fragment (Fab) that binds dabigatran (a direct thrombin inhibitor) with 350-fold higher affinity than thrombin, providing immediate, complete, and sustained reversal. The RE-VERSE AD trial demonstrated normalisation of coagulation parameters within minutes in >98% of patients. Dose: 5 g IV (two 2.5 g vials given consecutively). Idarucizumab is specific to dabigatran only; it does not reverse factor Xa inhibitors (which require andexanet alfa or four-factor PCC). Protamine reverses heparin. Vitamin K reverses warfarin. Knowing which reversal agent matches which anticoagulant is essential for emergency management.

Reference: BNF; ESC (2024): AF Guidelines