What is the most appropriate reversal agent for dabigatran in the event of an intracranial hemorrhage?

In the event of an intracranial hemorrhage induced by dabigatran, idarucizumab is the most appropriate reversal agent. Idarucizumab is a monoclonal antibody fragment specifically designed to bind to dabigatran and its active metabolites, effectively reversing the anticoagulant effects. This rapid and targeted mechanism allows for immediate management of bleeding complications, which is critical in emergencies like intracranial hemorrhage.

Protamine is a reversal agent for heparin and low molecular weight heparins but is ineffective against dabigatran. Fresh frozen plasma (FFP) can be useful in some cases of coagulopathy but does not specifically reverse the effects of dabigatran. Andexanet alfa is an antidote for factor Xa inhibitors, which does not apply to dabigatran, a direct thrombin inhibitor. Therefore, in the context of dabigatran-associated bleeding, idarucizumab stands out as the dedicated and effective reversal agent.