Dabigatran Perioperative Guide: Renal Tiers, Hold and Restart

This guide uses a conservative approach that respects renal clearance and neuraxial safety. It is an original summary. Confirm local policy before acting.

Why creatinine clearance matters

Dabigatran depends on renal elimination. As creatinine clearance falls, drug exposure increases. That is why perioperative holds and restarts scale with renal function.

Hold timing by procedure risk and renal tier

Use the procedure bleeding risk as the first step. Low or moderate risk often needs a shorter hold. High risk and any neurosurgical or neuraxial setting needs a longer hold. For lower creatinine clearance, extend holds conservatively. In very low clearance, avoid neuraxial techniques with dabigatran.

Neuraxial cautions and hard stops

For epidural, spinal, or intrathecal plans, be conservative. If renal function is poor, treat dabigatran as a neuraxial hard stop. Do not proceed with neuraxial in that setting.

Catheter gating

If a neuraxial catheter is in place, do not give dabigatran. After removal, the earliest dose is removal plus 24 hours. The real restart is the later of that time or the baseline post operative window.

When to restart dabigatran

Restart only when hemostasis is secure. Low or moderate risk procedures usually restart earlier than high risk or neuraxial settings. Clinical course and renal function guide the exact timing.

FAQ

How long to hold dabigatran before surgery

It depends on bleeding risk and creatinine clearance. Lower clearance leads to longer holds.

Can I bridge dabigatran

No. DOACs are not bridged. If thrombosis risk is extreme, discuss rare exceptions with Hematology.

When to restart after surgery

After hemostasis is secure. Adjust by risk category and renal function. Be more conservative for neuraxial cases.

For patient specific timestamps that respect renal tiers, use the AnticoagPlanner calculator.

Sources

• MD Anderson. Peri Procedure Anticoagulants, V8 approved 2025.
• Institutional neuraxial catheter timing summaries derived from ASRA guidance.