Question: Which recombinant immunoglobulin has been suggested as a useful therapy in the reversal of dabigatran associated bleeding? What is the proposed mechanism for this reversal effect?
Answer: The cited reference notes that “Idarucizumab is a recombinant immunoglobulin G1 iso-type molecule that binds specifically to the thrombin binging site of dabigatran and its metabolites with an affinity that is approximately 350 times greater than the affinity of dabigatran to thrombin, resulting in the inability of dabigatran to thrombin resulting in the inability of dabigatran to bind thrombin.” (Miller L et al. Idarucizumab for reversal of dabigatran-associated bleeding: misnomer or miracle? 2017 J Emerg Med 52(3): 341-347 and Schiele F et al. A specific antidote for dabigatran: functional and structural characterization. 2013 Blood 121: 3554-3562)