Dabigatran (Pradaxa) is an oral direct thrombin inhibitor.
A specific antidote (idarucizumab, Praxbind) against dabigatran is available and
can be given in emergency cases of acute bleeding.
Elimination half-life of dabigatran is 13–18 hours.
Surgery should be delayed for 24–48 hours after administration of the last dose. Bridging anticoagulation is not recommended. Neuraxial blockade is contraindicated.
Consider renal dialysis or giving rFVIIIa (NovoSeven) or aPCC (Beriplex) in case of acute bleeding.
Resume dabigatran 24–48 hours postoperatively or switch to thromboprophylaxis with LMWH 12–24 hours postoperatively depending on the individual postoperative bleeding risk or risk for thromboembolic complications.
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