Direct oral anticoagulants (DOACs) have largely replaced warfarin for NVAF. Regarding dabigatran, which statement is CORRECT?

• A Dabigatran inhibits factor Xa and has a specific reversal agent (andexanet alfa)
• B Dabigatran is a direct thrombin (factor IIa) inhibitor; its specific reversal agent is idarucizumab ✓
• C Dabigatran is hepatically metabolised by CYP3A4 and requires INR monitoring
• D Dabigatran inhibits factor Xa and requires no dose adjustment in renal impairment

Explanation

Dabigatran etexilate is a prodrug converted to dabigatran—a direct competitive thrombin (factor IIa) inhibitor. Its specific reversal agent is idarucizumab (a monoclonal antibody fragment that binds dabigatran with 350-fold greater affinity than thrombin). Rivaroxaban and apixaban are factor Xa inhibitors reversed by andexanet alfa. Dabigatran is NOT metabolised by CYP enzymes (excreted 80% renally unchanged), so it requires dose reduction in renal impairment (avoid if CrCl <30 mL/min for AF indication).

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.