Urgent surgery or life-threatening bleeding requires prompt reversal of the 
anticoagulant effects of dabigatran. This study assessed the ability of three- 
and four-factor prothrombin complex concentrate (PCC) and idarucizumab (specific 
antidote for dabigatran) to reverse the anticoagulant effects of dabigatran in a 
porcine model of trauma. Twelve animals were given dabigatran etexilate (DE) 
orally and dabigatran intravenously, before infliction of trauma. Six animals 
received tranexamic acid plus fibrinogen concentrate 12 minutes post-injury. Six 
PCCs (each 30 and 60 U/kg) and idarucizumab (30 and 60 mg/kg) were added to 
blood samples ex vivo. Coagulation was assessed by several coagulation assays. 
All coagulation parameters were altered after dabigatran infusion (plasma level: 
442 ± 138 ng/ml). Both three- and four-factor PCCs mostly or completely reversed 
the effects of dabigatran on thromboelastometry variables and PT but not on 
aPTT. Idarucizumab neutralised plasma concentrations of dabigatran, and reversed 
the effects of the drug on coagulation variables. Thrombin generation showed 
dose-dependent over-correction following the addition of PCC, implying that 
elevated levels of thrombin are required to overcome dabigatran-induced 
coagulopathy. In contrast, treatment with idarucizumab returned thrombin 
generation to baseline levels. Following trauma, therapy with tranexamic acid 
plus fibrinogen improved correction of coagulation parameters by PCC, and 
thromboelastometry parameters by idarucizumab. All investigated PCCs improved 
dabigatran- and trauma-induced coagulopathy to a similar degree. In conclusion, 
this study shows that three- and four-factor PCCs are similarly effective for 
dabigatran reversal. Idarucizumab also reversed the effects of dabigatran and, 
unlike PCCs, was not associated with over-correction of thrombin generation.