Idarucizumab for Dabigatran Reversal - Full Cohort Analysis
NEJM, 2017 · Multicenter open-label prospective cohort study (n=503)
Clinical question
Does idarucizumab rapidly and completely reverse the anticoagulant effect of dabigatran in patients with life-threatening bleeding or urgent surgery?
What the trial found
Idarucizumab achieves immediate, complete, and sustained reversal of dabigatran without prothrombotic excess.
Current guideline position
Class I recommendation in ACC, ASH, and neurocritical care reversal guidelines.
Clinical interpretation
Established Idarucizumab (Praxbind) 5 g IV as the definitive specific reversal agent for dabigatran-associated hemorrhage.
UFH vs LMWH vs DTIs (Argatroban/Bivalirudin), anti-Xa vs aPTT monitoring, and emergency reversal (Protamine, 4F-PCC, Idarucizumab; historical andexanet evidence with current availability caveats).
The trauma lethal diamond (hypothermia, acidosis, coagulopathy, hypocalcemia), 1:1:1 massive transfusion (PROPPR trial), early TXA (CRASH-2), and TEG/ROTEM algorithms.
Spontaneous ICH vs Aneurysmal SAH, INTERACT-2/ATACH-2 blood pressure targets, emergency anticoagulant reversal, ENRICH minimally invasive evacuation, ISAT coiling, and Nimodipine for delayed cerebral ischemia.