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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