It acts by competitively displacing dabigatran from thrombin to reverse anticoagulation and restore fibrin formation. Idarucizumab (aDabi-Fab/BI 655075/Boehringer Ingelheim, Germany) is a humanized, monoclonal, antibody fragment that specifically binds with high affinity to dabigatran, an oral direct thrombin inhibitor (DTI), also developed by Boehringer Ingelheim. ![]() 4 Currently, there are three specific reversal drugs for DOACs under clinical development (see Table 1). Although the latter have short half-lives, which suggests reversal drugs may not be needed in non-urgent situations, the lack of such antidotes is a concern in emergency situations such as life-threatening major bleeding or non-elective major surgery. 1-3 Unlike warfarin and other vitamin K antagonists, there are no specific antidotes available to reverse the anticoagulant effect of DOACs. In the past decade, the use of direct oral anticoagulants (DOACs apixaban, dabigatran, edoxaban, rivaroxaban) has been approved for a number of conditions such as the prevention of stroke in patients with non-valvular atrial fibrillation (AF) the prevention of venous thromboembolism (VTE) after hip or knee replacement surgery and the treatment of VTE, as well as the prevention of VTE recurrence. Clear guidance should be available at the time these reversal drugs are commercialized to promote their appropriate use. Additional research is also needed to determine impact on clinical practice.
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