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DOAC-Associated Intracerebral Haemorrhage — SCE Neurology MCQ

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HardCerebrovascular DiseaseDOAC-Associated Intracerebral HaemorrhageSCE Neurology

An 81-year-old taking dabigatran presents with an expanding spontaneous intracerebral haemorrhage. The final dose was four hours ago and renal function is impaired. Which specific reversal strategy is preferred?

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Correct answer: E — Idarucizumab; consider four-factor prothrombin complex concentrate only if it is unavailable

Idarucizumab specifically and rapidly reverses dabigatran and is the preferred treatment for dabigatran-associated intracerebral haemorrhage. Four-factor prothrombin complex concentrate is considered if idarucizumab is unavailable. Andexanet targets factor Xa inhibitors, vitamin K reverses vitamin K antagonists, and plasma is not the specific antidote.

Reference: National Clinical Guideline for Stroke, acute care: https://www.strokeguideline.org/chapter/acute-care/