Preclinical evidence that short-term cessation of dabigatran, a novel oral anticoagulant (NOAC), induces a rebound prothrombotic state and likely increases the risk of arterial thrombosis; this can potentially be prevented by aspirin pretreatment.
NOAC cessation should not be recommended for patients prior to minor surgical procedures with a low risk of bleeding; and if required, should not be discontinued for longer than outlined in the guidelines (i.e. ≤1 or 2 days).
Why this matters
A substantial proportion of patients on NOACs cease treatment prior to surgical procedures; evidence suggests that these patients face increased risk of stroke and thromboembolism.
It remains unclear if short-term cessation of dabigatran induces a paradoxical rebound prothrombotic state beyond the simple reversal of the anticoagulant effect.
These findings will inform clinical decisions regarding NOAC cessation in patients, and the management thereof.