Mazen H. Shaheen, MD Division of Cardiology, Department of Internal Medicine, University of Tennessee Health Sciences Center, Memphis
Pranab Das, MD Division of Cardiology, Department of Internal Medicine, University of Tennessee Health Sciences Center, Memphis
Santhosh K.G. Koshy, MD Division of Cardiology, Department of Internal Medicine, University of Tennessee Health Sciences Center, Memphis
Sunil K. Jha, MD Division of Cardiology, Department of Internal Medicine, University of Tennessee Health Sciences Center, Memphis
Rajesh Kabra, MD Division of Cardiology, Department of Internal Medicine, University of Tennessee Health Sciences Center, Memphis rkabra@uthsc.edu
Dr. Das reports that he is on the speakers’ bureau of AstraZeneca. Dr. Kabra reports that he serves on the speakers’ bureau of Boehringer Ingelheim. Drs. Shaheen, Koshy, and Jha reported no potential conflict of interest relevant to this article.
TABLE 3 Recommendations for withholding dabigatran before elective surgery29
Renal function (creatinine clearance), mL/min
Estimated half-life (range), h
Discontinue dabigatran before surgery
High risk of bleeding*
Standard risk
>50-80
~15 (12-17)
2-3 days before
24 hours before (2 doses)
30-50
~18 (18-24)
4 days before
At least 2 days (48 hours) before
<30
~27 (>24)
>5 days before
2-5 days before
*Surgeries that confer a high risk of bleeding include, but are not limited to, cardiac surgery, neurosurgery, abdominal surgery, or procedures involving a major organ. Procedures involving spinal anesthesia or spinal tap may also be considered as having a high risk of bleeding
CORRESPONDENCE Rajesh Kabra, MD, University of Tennessee Health Sciences Center, 1325 Eastmoreland Avenue, Suite 460, Memphis, TN 38104; rkabra@uthsc.edu
