Dabigatran is a direct oral anticoagulant (DOAC) that directly inhibits thrombin. Which feature makes it unique among DOACs compared to rivaroxaban and apixaban?
- A It inhibits both free and clot-bound Factor Xa
- B It is the only DOAC with a specific reversal agent (idarucizumab) that is a monoclonal antibody fragment ✓
- C It undergoes complete first-pass metabolism and must be given parenterally
- D It requires INR monitoring for dose adjustment
Correct answer: B. It is the only DOAC with a specific reversal agent (idarucizumab) that is a monoclonal antibody fragment
Explanation
Dabigatran is a direct thrombin (Factor IIa) inhibitor. Its specific reversal agent idarucizumab (Praxbind) is a humanized monoclonal antibody fragment that binds dabigatran with extremely high affinity, instantly reversing its anticoagulant effect. Andexanet alfa is the reversal agent for Factor Xa inhibitors (rivaroxaban, apixaban). Dabigatran is taken orally as a prodrug etexilate but has low bioavailability; DOACs do not require INR monitoring.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.