Acute management of ST-elevation myocardial infarction patients taking dabigatran.

The novel oral anticoagulant agents provide compelling evidence-based advance over warfarin therapy in nonvalvular atrial fibrillation and have received endorsement from contemporary guidelines. This case illustrates the challenge that clinicians will have to manage patients taking these agents who present with ST-elevation myocardial infarction requiring acute reperfusion therapy. We used a "logical" although not evidence-based approach to applying a pharmacoinvasive strategy that might be considered by others. Additionally we propose suggestions for urgent percutaneous coronary intervention while taking dabigatran, a strategy that should be implemented cautiously and adapted as further evidence becomes available.