A 71-year-old woman comes to the physician because of palpitations and shortness of breath that started 3 days ago. She has hypertension and congestive heart failure. Her pulse is 124/min, and blood pressure is 130/85 mm Hg. Cardiac examination shows an irregularly irregular rhythm without any murmurs. An ECG shows a narrow-complex tachycardia without P waves. The patient is prescribed a prophylactic medication that can be reversed with idarucizumab. The expected beneficial effect of the prescribed drug is most likely due to which of the following effects?

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Eductional Objective: Direct inhibition of thrombin is the mechanism of action of dabigatran, an oral anticoagulant used for stroke and venous thromboembolism prophylaxis. The effects of dabigatran can be reversed by administration of idarucizumab. Fresh frozen plasma, prothrombin complex concentrate, and/or antifibrinolytics (e.g., tranexamic acid) can be used if idarucizumab is not available. Idarucizumab does not reverse the effects of intravenously administered direct thrombin inhibitors such as argatroban and bivalirudin (structurally related to hirudin produced by leeches

A 71-Year-Old Woman Comes to the Physician Because of Palpitations