dabigatran

For minor procedures, dabigatran may not need to be discontinued. 

• Bleeding risk is similar to whilst on LMWH. 

• Assess the risk of bleeding against the risk of thrombosis.

If required to be withheld prior to surgery; timing is dependent on renal function. 

• If risk of thrombosis is high consider LMWH bridging. 

• Reversal with idarucizumab is costly and needs specialist approval.

• Elimination of dabigatran can be assessed by TCT. 

• An abnormal TCT is a contraindication for spinal / epidural anaesthesia.