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there has been a push in my health system to use Dabigatran in lieu of warfarin. The 3rd edition ASRA consensus statement does not have concrete information on the anesthetic management of both neuraxial (especially the removal of epidural catheters) and regional techniques for patients on Pradaxa. Any suggestions?.....

the half-life of dabigatran is 14-17 hrs. after multiple dose administration. I'm currently comfortable waiting at least 2 half lives (36 hours) for removal and waiting at least 12 hours before the next dose is administered. Or maybe more succinctly stated: there needs to be a window of 48 hours between the 2 doses when managing epidural catheter removal. [ [after 2 half-lives 25% of the drug remains active] ....there are some in my system which "strongly suggest" waiting at least 4 half lives before removing an epidural catheter [ 6.25% of the drug remains active after 4 half lives]? 4 half-lives puts us to 68 hours????.....Is that a realistic approach to manage epidural catheters in-house?

thanks