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<h3>Background and Importance</h3> Idarucizumab is indicated in patients treated with dabigatran who must undergo emergency surgery or who have uncontrolled bleeding. <h3>Aim and Objectives</h3> This study seeks to analyse the effectiveness and safety of idarucizumab use in a tertiary care hospital. <h3>Material and Methods</h3> Retrospective observational study of the use of idarucizumab from May-2016 to May-2024. Data were obtained from electronic medical records. The variables collected were: sex, age, creatinine, dabigatran indication, dabigatran treatment dose, continuation of dabigatran treatment during the year following the event studied, and idarucizumab indication. Effectiveness was measured by improvement in bleeding or possibility of surgical intervention. Safety was studied as the incidence of death during the 5 days after idarucizumab dosing and the incidence of thromboembolism and/or bleeding at 90 days. Qualitative variables were expressed as percentages, continuous quantitative variables were expressed as median and interquartile range. <h3>Results</h3> Thirty patients were analysed. The median age was 80 (68.5-91.5) years. 70% were men. All patients were being treated with dabigatran for the prevention of stroke and systemic embolism secondary to AF. The median creatinine level was 1.26(0.11-2.41) mg/dL, 67% received 110mg/12h , 30% received 150mg/12h, and 3% received 75mg/12h. The indication for idarucizumab use was: 56% uncontrolled bleeding, 34% emergency surgery, 7% dabigatran overdose and 3% multiple organ shock. The dose of idarucizumab administered was 5g in 100% of patients. In the 100% of the cases, surgery could be performed or bleeding reduced. One death was recorded during the first 5 days after the idarucizumab dose. At 90 days, 17% of incidents of thromboembolism and/or bleeding were recorded. After treatment with idarucizumab, 43% of patients discontinued treatment with dabigatran. Among them, 37% were switched to acenocoumarol, 25% to an anti-Xa agent, and 25% to heparin. The remaining 13% had their anticoagulant treatment permanently discontinued. <h3>Conclusion and Relevance</h3> Idarucizumab was used in 90% of patients under indications approved in the summary of product characteristics. Its effectiveness in these patients was 100%. One death was reported in the first 5 days after administration of idarucizumab and 17% of thromboembolic events and/or bleeding at 90 days. Two out of five patients treated with idarucizumab changed or discontinued anticoagulant therapy. <h3>Conflict of Interest</h3> No conflict of interest