A New Benefit for a Direct-Acting Oral Anticoagulant?

Almost daily, every cardiology consultation service receives calls from surgeons asking for referrals for their patients who have an elevated troponin measurement after noncardiac surgery. The reason for troponin testing is often obscure, but the presence of an elevated level is associated with a higher risk for an adverse vascular outcome. Investigators in the multisite, international, manufacturer-funded MANAGE trial sought to determine whether a direct oral anticoagulant, dabigatran, could lower this risk (NCT01661101).

The investigators randomized 1754 patients aged ≥45 who were within 35 days of an elevated troponin test after noncardiac surgery to an intermediate dose of dabigatran (110 mg orally twice daily) or placebo (mean age, 70; …