Tthe anticoagulant effect of dabigatran was fully reversed in 89% of patients at 4 hours following administration of idarucizumab, according to the FDA. The product comes in 2 vials each containing 2.5 g/50 mL, which can be given as 2 separate infusions or as a bolus by giving both vials consecutively via syringe. Keep in mind that the elimination half-life of dabigatran is approximately 12 to 17 hours, on average. If there is no need for urgent reversal, then it may be better to withhold the drug and allow it to be cleared by the patient. Praxbind is indicated when reversal of the anticoagulant effects of dabigatran is needed for emergent surgery or urgent procedures and in life-threatening or uncontrolled bleeding, so it’s best to investigate whether these criteria are met.To avoid a potential waste of resources, the patient’s use of dabigatran should be confirmed. Because idarucizumab only reverses dabigatran, it won’t be effective if the patient is taking another anticoagulant such as warfarin or a factor Xa inhibitor such as rivaroxaban, apixaban or edoxaban. Obtain an accurate medication history.Idarucizumab is a monoclonal antibody specifically targeted at dabigatran, meaning it won’t reverse the effects of other oral anticoagulants.Here are 7 things pharmacists need to know before recommending the use of idarucizumab:

With the approval of idarucizumab, clinicians will have a more efficient tool to use for the reversal of dabigatran. Activate 4-factor prothrombin complex concentrate or recombinant factor VIIa to reverse the effects of the drug (off-label uses that made clinicians worry about thrombosis).Dialysis to assist the patient in clearing the drug (may be difficult to obtain access for dialysis catheters).

Supportive therapy to allow the patient to clear the dabigatran (not a great option for a patient with life-threatening bleeding).When health care providers were previously faced with the need for urgent reversal of dabigatran, there were few options available, and none of them were ideal in life-threatening situations.

The FDA has granted accelerated approval for Boehringer Ingelheim’s idarucizumab (Praxbind), the first product specifically targeted to reverse the effects of dabigatran (Pradaxa).

Praxbind dose