When should Pradaxa be discontinued before surgery for patients with CrCl>50?

For patients with a creatinine clearance (CrCl) greater than 50 mL/min, Pradaxa (dabigatran etexilate) should typically be discontinued about 2 days before surgery. This recommendation is based on the pharmacokinetics of the medication, where it has a half-life of approximately 12 to 17 hours in individuals with normal renal function. Discontinuing the medication two days prior allows sufficient time for the drug to be cleared from the system, minimizing the risk of bleeding during the surgical procedure.

This strategy seeks to balance the risk of thromboembolic events with the need to prevent excessive bleeding during surgery. The timing also considers the patient's overall renal function, which can affect the drug's elimination. In contrast, other suggested durations may either not provide enough clearance time or reflect risk management protocols that are not as widely endorsed for patients with normal renal function. Discontinuing the drug too early could leave the patient vulnerable to thromboembolic events, while too short a duration increases the risk of surgical bleeding.