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Idarucizumab (Praxbind) 💊
💉 Idarucizumab (Praxbind) is a monoclonal antibody fragment that binds specifically to dabigatran and reverses its anticoagulant effect. ⚠️ It does not reverse other anticoagulants (e.g. warfarin, apixaban, rivaroxaban). 👉 Always check the BNF for up-to-date prescribing advice.
🧪 Mode of Action
- Humanised monoclonal antibody fragment.
- Binds dabigatran and its metabolites with high affinity → neutralises anticoagulant activity.
📌 Indications
- Emergency surgery / urgent invasive procedure in a patient on dabigatran.
- Life-, limb- or sight-threatening bleeding on dabigatran.
💊 Dose
- Total = 5 g IV.
- Administer as either:
- Two consecutive 2.5 g/50 ml infusions (each over 5–10 minutes), OR
- Two consecutive 2.5 g bolus injections.
🔬 Interactions / Monitoring
- Renal impairment does not alter reversal effect.
- Dabigatran prolongs clotting markers: diluted thrombin time (dTT), thrombin time (TT), aPTT, ecarin clotting time (ECT).
- These can be used to assess anticoagulation intensity pre- and post-reversal.
⚠️ Cautions
- See BNF for full cautions.
- Risk of thrombosis once anticoagulation is reversed – balance need for restarting anticoagulation early once safe.
⛔ Contraindications
- None absolute beyond hypersensitivity (see BNF).
😷 Side Effects
- Headache.
- Electrolyte imbalance (esp. altered potassium).
- Delirium, confusion.
- Constipation, pyrexia, pneumonia.
- Thrombotic risk (due to loss of anticoagulation).
📚 References
- BNF: Idarucizumab
- Pollack CV et al. (2015). Idarucizumab for Dabigatran Reversal. NEJM.
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