Patients with an indication for antithrombotic therapy are one of the most vulnerable and high-risk populations with SAB by virtue of their age and medical complexity. S. aureus virulence is partly mediated through platelet injury and virulence factors which act along the thrombotic pathway

Although antithrombotic therapy has proven effective in other infections and has elicited improvements in patient-relevant outcomes, no RCTs have ever studied antithrombotic therapies to improve outcomes for SAB patients.

Patients are eligible for this domain if they meet all of the platform-level inclusion and none of the platform-level exclusion criteria AND all of the domain-level inclusion and none of the domain-level exclusion criteria.

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Domain-specific inclusion criteria

• Patient is taking an oral Xa inhibitor for: stroke prevention in atrial fibrillation, treatment or secondary prevention of deep venous thrombosis or pulmonary embolism, prevention of VTE in patients who have undergone elective total hip or total knee replacement surgery, so long as 30 or more days of planned therapy are remaining at the time of enrolment.

Domain-specific exclusion criteria

• Active bleeding (determined by site investigator and treating team)
• Anticipated major cardiac surgery, neurosurgery, or spine surgery within the next 3 days
• Pregnancy (confirmed based on testing)
• Lactation
• Known use of dabigatran within the last month
• Allergy to dabigatran
• Concomitant use of amiodarone, ketoconazole, rifampin, verapamil, clopidogrel, prasugrel, or ticagrelor
• eGFR <30ml/minute calculated by Cockcroft-Gault equation using adjusted weight
• Off label use (eg. metallic mechanical heart valve, left ventricular thrombus)
• Any other contraindication to dabigatran

Patients will be randomised to one of the following:

• Continue oral Xa inhibitor
• Change to dabigatran

Treatment interruption for procedures, bleeding, or surgery, which may occur in both intervention groups, are managed according to local practices and policies.

Lead Investigator: Dr Emily G. McDonald

Email: emily.mcdonald@mcgill.ca

This nested trial is registered on ClinicalTrials.gov: NCT06650501