Q: In case of  overdose or bleeding secondary to Dabigatran, all of the following can be parts of management except? 

 A) tranexamic acid (antifibrinolytics) 
B) activated charcoal 
C) hemodialysis 
D) idarucizumab 
E) prothrombin complex concentrate (aPCC) 
F) idarucizumab + aPCC


Answer: F


Dabigatran is the only out of all direct oral anticoagulants (DOACs) which has reversal available, as well as it is dialysable (choice C). 

Idarucizumab (choice D) consists of humanized dabigatran-specific (Fab) antibody fragments (kind of Digibind!!). 

All other choices (A, B, E) are standards of treatment in life-threatening bleeding or overdoses secondary to DOACs. 

As idarucizumab is so new, data on its prothrombic property is extremely limited, and  aPCCs itself is very prothrombotic. Combining both of these can itself be very life threatening (Choice F) on the other end of the spectrum.


References:

1. Schiele F, van Ryn J, Canada K, et al. A specific antidote for dabigatran: functional and structural characterization. Blood 2013; 121:3554.

2. Chai-Adisaksopha C, Hillis C, Lim W, et al. Hemodialysis for the treatment of dabigatran-associated bleeding: a case report and systematic review. J Thromb Haemost 2015; 13:1790.