# 一位因心房顫動服用 dabigatran 的病人，到院時發生重大顱內出血。醫師需要立即逆轉抗凝血作用。護理師應預期使用何種藥物？

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

## 題目

一位因心房顫動服用 dabigatran 的病人，到院時發生重大顱內出血。醫師需要立即逆轉抗凝血作用。護理師應預期使用何種藥物？

## 選項

1. 維生素K 10 mg IV — dabigatran之逆轉劑。
2. Idarucizumab(Praxbind) — 人源化單株抗體片段，特異性結合dabigatran，為FDA核准之逆轉劑。 **✔ 正確答案**
3. Protamine sulfate — dabigatran之逆轉劑。
4. Andexanet alfa — dabigatran之逆轉劑。

**正確答案: 2**

## 解析

抗凝血劑逆轉對照：warfarin → 緊急時使用維生素 K 加上四因子凝血酶原複合濃縮物，heparin／低分子量 heparin → protamine sulfate，dabigatran → idarucizumab（Praxbind），apixaban／rivaroxaban（第十凝血因子抑制劑）→ andexanet alfa，若無法取得 andexanet 則使用四因子凝血酶原複合濃縮物。Dabigatran 是一種直接凝血酶抑制劑，idarucizumab 是唯一經 FDA 核准的特定逆轉劑。

## 深入解析

記憶配對：warfarin = 維生素K + PCC、heparin = protamine、dabigatran = idarucizumab、Xa因子抑制劑 = andexanet alfa。錯誤配對為最常考之NCLEX抗凝劑題。Protamine對dabigatran無逆轉效果；維生素K亦無效。

## 臨床情境

心房顫動服用**dabigatran**之成人於CT檢出**主要顱內出血**。醫師計畫緊急逆轉抗凝劑。

## 重要概念

- **Idarucizumab(Praxbind)** — FDA核准之dabigatran特異性逆轉劑；數分鐘內以高親和力結合dabigatran。
- **Andexanet alfa(Andexxa)** — Xa因子抑制劑apixaban與rivaroxaban之逆轉劑；重組誘餌Xa因子。
- **4因子PCC** — 凝血酶原複合物濃縮液；致命出血中warfarin緊急逆轉之第一線；較FFP更快速。

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