A patient on dabigatran for atrial fibrillation arrives with… | MyMerci
NCLEX-RNROR
Question
A patient on dabigatran for atrial fibrillation arrives with a major intracranial hemorrhage. The provider needs the anticoagulant reversed immediately. Which agent should the nurse anticipate?
1Vitamin K 10 mg IV — the reversal agent for dabigatran.
2Idarucizumab (Praxbind) — a humanized monoclonal antibody fragment that specifically binds dabigatran and is the FDA-approved reversal agent.✓ Correct answer
3Protamine sulfate — the reversal agent for dabigatran.
4Andexanet alfa — the reversal agent for dabigatran.
Explanation
Anticoagulant reversal mapping: warfarin → vitamin K + 4-factor PCC (urgent), heparin/LMWH → protamine sulfate, dabigatran → idarucizumab (Praxbind), apixaban/rivaroxaban (factor Xa inhibitors) → andexanet alfa or 4-factor PCC if andexanet unavailable. Dabigatran is a direct thrombin inhibitor; idarucizumab is the only specific FDA-approved reversal agent.
In-depth explanation
Memorize the matching: warfarin = vitamin K + PCC, heparin = protamine, dabigatran = idarucizumab, factor Xa inhibitors = andexanet alfa. Wrong-pairing is the most-tested NCLEX anticoagulant question. Protamine on dabigatran does NOT reverse it; vitamin K on dabigatran does NOT reverse it.
Clinical scenario
Adult patient with atrial fibrillation on dabigatran arrives with major intracranial hemorrhage on CT. The provider plans emergent reversal of anticoagulation.
Key concepts
Idarucizumab (Praxbind) — FDA-approved reversal agent specifically for dabigatran; binds dabigatran with high affinity within minutes.
Andexanet alfa (Andexxa) — Reversal agent for factor Xa inhibitors apixaban and rivaroxaban; recombinant decoy factor Xa.
4-factor PCC — Prothrombin complex concentrate; first-line for warfarin emergency reversal in life-threatening bleeding; faster than FFP.