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Dabigatran-Treated Patients who Elect Surgery
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Sam Schulman, MD of McMaster University discusses his ISTH 2015 presentation that evaluated a management protocol of dabigatran-anticoagulated patients who elect surgery. The investigators utilized a pre-specified management protocol and studied 541 patients that had elective procedures; almost all patients had a history of atrial fibrillation. There were 0 strokes and only 1 TIA reported (0.2% risk of arterial embolism). There were 10 major bleeding events (1.8%); several of the bleeding events occurred because of a major surgical procedure or the need for repeat surgery. Bridging of patients with heparin was prohibited, except in the case a patient was unable to take oral medications in the post-operative period. This type of protocol provides a suggested protocol for widespread implementation to streamline the management of NOAC-treated patients who elect surgery.