Therapy with dabigatran (Pradaxa) can be associated with severe hemorrhage. Idarucizumab (Praxbind) has been approved as an antidote for dabigatran-related bleeding.
Dabigatran is a direct thrombin inhibitor.
Idarucizumab is a monoclonal antibody fragment targeting dabigatran.
Indications - a patient being treated with dabigatran with one or more of the following:
(1) need for urgent surgery
(2) need for urgent thrombolysis for stroke
(3) life-threatening or uncontrolled bleeding
Usual dosing: 5 grams (two vials with 2.5 g/vial. each given as a 50 mL infusion)
Anticoagulation reversal: usually within 10 minutes
Drug interactions:
(1) quinidine
Significant complications:
(1) thrombosis
(2) hypersensitivity reaction
(3) sorbitol intolerance if the patient has hereditary fructose intolerance
(4) hypokalemia
