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Anesthesia in a Patient on Anticoagulant Dabigatran Presenting for Emergency Surgery

Dabigatran is an anticoagulant which acts by directly inhibiting the specific coagulation factors. It is used as a safe alternative to warfarin. This agent provides multiple benefits over warfarin which includes fixed dosing, lower incidence of hemorrhagic stroke, and no need of routine monitoring. Dabigatranetexilate (prodrug) is a direct thrombin inhibitor whereas rivaroxaban, edoxaban, and apixaban act by inhibiting factor Xa. Dabigatran is excreted through kidney (80%), so the dosage should be adjusted according to the creatinine clearance value. Life-threatening bleeding caused by dabigatran can be managed with its specific antidote idarucizumab to reverse its action. Factor 3 or 4 prothrombin concentrate complex may still be required in patients who bleed even after idarucizumab. Detailed knowledge about this medication can contribute to decrease in morbidity and improved outcome.