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.