Dabigatran: a primer for neurosurgeons.
OBJECTIVE
This study sought to present an overview of dabigatran, a new anticoagulant, and to discuss the implications for the perioperative management of patients taking dabigatran.


METHODS
We reviewed the English literature pertaining to the new oral anticoagulant, dabigatran (Pradaxa).


RESULTS
Dabigatran has the advantage of providing rapid and steady anticoagulation without requiring laboratory monitoring. However, the fact that no practical, reliable method of monitoring of the anticoagulant effects is available constitutes a challenge when contemplating urgent neurosurgical procedures in patients treated with this medication. Although the risk of intracranial hemorrhage with dabigatran was lower than with warfarin in the large trial leading to the approval of the drug, the management of these complications may be problematic because there is no current antidote.


CONCLUSIONS
We present a basic overview of dabigatran, discuss the implications for the perioperative management of patients taking this new anticoagulant, and offer recommendations for the management of intracranial hemorrhage related to this drug.
Division of Critical Care Neurology, Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
Jennifer E
JE
Fugate
Alejandro A
AA
Rabinstein
Robert D
RD
McBane
Giuseppe
G
Lanzino
D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects; D001562:Benzimidazoles / Q000008:administration & dosage* / Q000009:adverse effects*; D001777:Blood Coagulation / Q000187:drug effects; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D000069604:Dabigatran; D006801:Humans; D009493:Neurosurgery; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000139:chemically induced / Q000517:prevention & control*; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
D000991:Antithrombins; D001562:Benzimidazoles; D015091:beta-Alanine; D000069604:Dabigatran