Anticoagulants (Figure 4.9)
Figure 4.9
Consider coordinating with physician and surgeon to establish a plan regarding adjusting anticoagulants for an elective procedure, balancing the risk between re‐thrombosis and postoperative hemostasis
Direct Thrombin Inhibitors
Dabigatran
Hirudin
Mechanism of Action
Directly binds and inhibits thrombin
Clinical Implications
Local hemostasis techniques
Minimally invasive procedure
Continue drug perioperatively [23]
Moderate/high bleeding expected
Discuss with surgeon and physician
Consider delaying elective cases until patient no longer requires anticoagulant therapy
Consider heparin bridge therapy for high‐risk patients
Discontinuation time depends on renal function [24]
Reversal
Dabigatran
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