Dabigatran Reversal — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

EasyEmergency MedicineDabigatran ReversalRACP Adult Medicine

A 60-year-old man on dabigatran 150 mg BD for AF requires urgent surgery for a perforated viscus. His last dose of dabigatran was 6 hours ago. What reversal agent should be administered?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Idarucizumab 5 g IV

Idarucizumab is the specific reversal agent for dabigatran (a direct thrombin inhibitor). It is a humanised monoclonal antibody fragment that binds dabigatran with 350× greater affinity than thrombin. The dose is 5 g IV (given as 2 × 2.5 g boluses). It provides complete reversal within minutes. Andexanet alfa is specific for factor Xa inhibitors (rivaroxaban, apixaban). PCC may be used if idarucizumab is unavailable. Vitamin K has no role in DOAC reversal.

Reference: eTG – 2025 – Haematology; AMH – 2025 – DOAC Reversal Agents