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

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