Idarucizumab is used to reverse dabigatran anticoagulation. Its mechanism of action is:

• A Competitive inhibition of dabigatran at the thrombin active site
• B Recombinant factor Xa that sequesters dabigatran away from endogenous thrombin
• C Heparin-binding protein that reverses dabigatran by displacing it from glycosaminoglycan sites
• D A humanised monoclonal antibody fragment (Fab) that binds dabigatran with >300-fold higher affinity than thrombin ✓

Explanation

Idarucizumab is a humanised monoclonal antibody fragment (Fab) that binds dabigatran and its acylglucuronide metabolites with an affinity (~1 pmol/L Ki) approximately 350-fold higher than dabigatran's affinity for thrombin. This tight binding effectively sequesters free dabigatran, rapidly reversing anticoagulation. Andexanet alfa reverses factor Xa inhibitors (rivaroxaban, apixaban), not dabigatran.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.