Cardiovascular drugs: reversal of dabigatran: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Cardiovascular drugs: reversal of dabigatran

Sample item

A 78-year-old man with atrial fibrillation on dabigatran develops an intracranial haemorrhage 3 hours after his last dose. Which agent specifically reverses the anticoagulant?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Idarucizumab

Idarucizumab is a humanised antibody fragment that binds dabigatran with high affinity and reverses its effect within minutes. Vitamin K reverses warfarin, protamine neutralises heparin, and andexanet alfa reverses the factor Xa inhibitors rivaroxaban and apixaban. Prothrombin complex concentrate is an alternative when idarucizumab is unavailable.

Option by option

  • A. Idarucizumab (correct)

    Correct. It is the specific antidote for the direct thrombin inhibitor dabigatran.

  • B. Protamine sulfate

    Protamine binds the negatively charged heparins, not dabigatran.

  • C. Andexanet alfa

    Andexanet alfa is a decoy factor Xa and does not neutralise a thrombin inhibitor.

  • D. Vitamin K intravenously

    Vitamin K restores vitamin K-dependent factors and does not act on dabigatran.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Pharmacology questions

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is A, Idarucizumab. Idarucizumab is a humanised antibody fragment that binds dabigatran with high affinity and reverses its effect within minutes.

Why is "Protamine sulfate" not the answer?

Protamine binds the negatively charged heparins, not dabigatran.

Why is "Andexanet alfa" not the answer?

Andexanet alfa is a decoy factor Xa and does not neutralise a thrombin inhibitor.

Why is "Vitamin K intravenously" not the answer?

Vitamin K restores vitamin K-dependent factors and does not act on dabigatran.

What concept does this question test?

It tests Cardiovascular drugs: reversal of dabigatran in Pharmacology. Vitamin K reverses warfarin, protamine neutralises heparin, and andexanet alfa reverses the factor Xa inhibitors rivaroxaban and apixaban. Prothrombin complex concentrate is an alternative when idarucizumab is unavailable.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiovascular drugs: reversal of dabigatran?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.