This retrospective audit reviews patients on dabigatran presenting with bleeding or requiring urgent surgery in the Wellington region, whether they received idarucizumab appropriately and the outcome of episodes. Eighty patients were identified with bleeding or need for urgent surgery, 14 of which received idarucizumab. In patients who received idarucizumab, use was safe, effective and overall appropriate. Idarucizumab was underutilised with patients who could have benefited not receiving it; however, some patients who were treated may not have required it. Increased awareness and use may improve outcomes.