OBJECTIVE: To evaluate the role of idarucizumab, a humanized monoclonal antibody 
fragment, as a specific reversal agent for the anticoagulant activity of 
dabigatran and to review the pharmacology, pharmacokinetic properties, efficacy, 
and safety of this agent.
METHODS: A literature search was conducted consisting of a PubMed database using 
the MeSH term idarucizumab and the key word dabigatran antidote. Studies 
evaluating the pharmacology, pharmacokinetics, safety, and efficacy of 
idarucizumab for the reversal of the anticoagulant activity of dabigatran were 
included.
RESULTS: Idarucizumab represents a novel treatment option as it is the only 
humanized, monoclonal antibody fragment that specifically binds to dabigatran. 
Studies evaluating reversal of dabigatran-induced anticoagulation have 
demonstrated immediate, complete, and sustained effects with idarucizumab. 
Idarucizumab did not overcorrect thrombin generation. Additionally, evaluations 
have shown that dabigatran can be safely reinitiated 24 hours after the 
administration of idarucizumab. The United States Food and Drug Administration 
granted priority review for the biologic license application and accelerated 
approval for idarucizumab.
CONCLUSION: Idarucizumab represents an encouraging development in the reversal 
of dabigatran. Its novel mechanism of action, pharmacokinetics, tolerability, 
and lack of thrombotic events contribute positively to its use in patients who 
experience bleeding or for those who require emergent surgery or procedures.