Prior to neuraxial block or deep plexus/peripheral block we suggest that a residual dabigatran plasma level <30 ng/mL is acceptable.

We suggest that needle placement/catheter removal occurs at least 24 hours prior to the first postoperative dose (high dose).

With the unanticipated administration of high-dose dabigatran with a neuraxial catheter in situ, we suggest that dabigatran dosing be withheld for at least 72 hours (120 hours if CrCl 30–49 mL/min) or a residual dabigatran plasma level <30 ng/mL before the catheter is removed.

We suggest that a low dose of dabigatran be discontinued for at least 48 hours prior to neuraxial block or deep plexus/peripheral block. Consider checking dabigatran plasma level if <48 hours.

We suggest that needle placement/catheter removal occurs at least 6 hours prior to the first postoperative dose (low dose).

With the unanticipated administration of low dose of dabigatran with a neuraxial catheter in situ, we suggest that dabigatran dosing be withheld for at least 48 hours, or a residual dabigatran plasma level <30 ng/mL before the catheter is removed.

The present available data suggest against the use of idarucizumab, andexanet alfa, PCC, or aPCC to reverse DOAC anticoagulant activity to enable the safe performance of a neuraxial intervention in routine patients.

We recommend daily review of the patient’s medical record to determine the concurrent use of medications that affect other pathways of hemostasis. These medications include antiplatelet medications, LMWH, and oral anticoagulants.

Since heparin-induced thrombocytopenia may occur during heparin administration, we recommend that patients receiving intravenous or subcutaneous UFH for >4 days have a platelet count assessed.

Discontinue heparin infusion for a minimum of 4–6 hours and coagulation status be assessed and normal prior to neuraxial block or deep plexus/peripheral block (intravenous heparin).