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Anticoagulant Reversal — Dabigatran

Idarucizumab

Brand names: Praxbind

Idarucizumab is a humanised monoclonal antibody fragment given intravenously as a specific reversal agent for the direct thrombin inhibitor dabigatran, used in life-threatening or uncontrolled bleeding or before urgent surgery.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It binds dabigatran and its acylglucuronide metabolites with very high affinity, neutralising their anticoagulant effect almost immediately and far more avidly than dabigatran binds thrombin.

Prescribing in practice

  • It reverses only dabigatran and confers no benefit against other anticoagulants, so confirm the patient is on dabigatran before use.
  • Reversal removes anticoagulation and re-exposes the patient to their underlying thrombotic risk, so resumption of antithrombotic therapy should be considered once clinically appropriate.
  • Re-elevation of clotting parameters can occur after the initial dose, and a hereditary fructose intolerance caution applies because of the sorbitol excipient.

Monitoring

Monitor clinical bleeding and, where available, dabigatran-sensitive coagulation assays to confirm reversal and detect any rebound.

Counselling the patient

  • Explain to the team that this is an emergency reversal agent specific to dabigatran.
  • Discuss when and how anticoagulation will be restarted to manage the underlying thrombotic risk.
  • Report any recurrence of bleeding after treatment.

Evidence & guidelines

The RE-VERSE AD study supported rapid reversal of dabigatran anticoagulation with idarucizumab.

Reference: Pollack et al. RE-VERSE AD (NEJM 2017); SPC Praxbind; NICE guidance; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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