# 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?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374916&lang=en  
> language: en  
> subject: NCLEX-RN  
> category: ROR

## 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?

## Option

1. Vitamin K 10 mg IV — the reversal agent for dabigatran.
2. Idarucizumab (Praxbind) — a humanized monoclonal antibody fragment that specifically binds dabigatran and is the FDA-approved reversal agent. **✔ Correct answer**
3. Protamine sulfate — the reversal agent for dabigatran.
4. Andexanet alfa — the reversal agent for dabigatran.

**Correct answer: 2**

## 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.

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