DOAC Reversal Agent — ORE Part 1 MCQ

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HardPharmacology & TherapeuticsDOAC Reversal AgentORE Part 1

A 70-year-old patient taking dabigatran twice daily experiences a fall and sustains a laceration to the oral mucosa with significant bleeding. The bleeding does not respond to local pressure. Which specific reversal agent is available for dabigatran?

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Reveal the answer and explanation

Correct answer: E — Idarucizumab

Explanation lettering: C = shown as A · D = shown as B · B = shown as C · E = shown as D · A = shown as E

The correct answer is idarucizumab (A). Idarucizumab is the only UK-licensed specific reversal agent for dabigatran. It is a humanised monoclonal antibody Fab fragment that binds with very high affinity to dabigatran and its metabolites, rapidly neutralising anticoagulant activity. The RE-VERSE AD trial demonstrated complete reversal in adults with serious bleeding or requiring urgent surgery. Andexanet alfa (B) is specific for apixaban and rivaroxaban, not dabigatran. Vitamin K (C) is used to reverse warfarin (a vitamin K antagonist), not DOACs. Fresh frozen plasma (D) and protamine sulphate (E) are non-specific supportive measures or agents for heparin reversal, respectively, and have no specific action against dabigatran.

Reference: NICE Evidence Summary ESNM73: Reversal of the anticoagulant effect of dabigatran: idarucizumab (May 2016). https://www.nice.org.uk/advice/esnm73/chapter/key-points-from-the-evidence