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Idarucizumab is a humanized monoclonal antibody fragment (Fab) that serves as a specific reversal agent for the direct thrombin inhibitor dabigatran. It binds to dabigatran and its metabolites with an affinity approximately 350 times higher than that of thrombin, effectively neutralizing the anticoagulant effect without possessing intrinsic procoagulant or anticoagulant activity. Developed by Boehringer Ingelheim, it was the first specific reversal agent approved for a non-vitamin K antagonist oral anticoagulant (NOAC). It is primarily indicated for patients treated with dabigatran (Pradaxa) who require rapid reversal of anticoagulation due to life-threatening or uncontrolled bleeding, or before emergency surgery or urgent procedures.
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