From the Research
For patients on dabigatran who require botulinum toxin injections, it is generally recommended to temporarily discontinue dabigatran 24-48 hours before the procedure, depending on renal function, as suggested by the most recent study 1. The decision to discontinue dabigatran is based on the patient's renal function, with those having normal renal function (CrCl ≥50 mL/min) typically stopping dabigatran 24 hours before the procedure, and those with impaired renal function (CrCl <50 mL/min) stopping 48 hours before, as supported by previous studies 2, 3. Key considerations include:
- The botulinum toxin injection itself carries minimal bleeding risk, but temporary discontinuation of dabigatran helps reduce potential bleeding complications.
- Dabigatran can usually be resumed 24 hours after the procedure if adequate hemostasis has been achieved.
- The short half-life of dabigatran (12-17 hours) allows for a relatively brief interruption with minimal risk, as noted in earlier research 4, 5.
- For patients at very high thrombotic risk, consultation with the prescribing physician is advised to determine if bridging therapy is needed during the interruption period, emphasizing the importance of individualized care.
- Always confirm the specific timing with the patient's cardiologist or prescribing physician, as individual patient factors may necessitate adjustments to this general guideline, highlighting the need for personalized management plans.