We thank Dr Chan for his observations and comments. The use of chronic anticoagulation is increasing and will likely continue to expand as the population ages. While warfarin is the most widely prescribed oral anticoagulant, the search for oral direct thrombin inhibitors to replace warfarin is attractive for many reasons including ease of monitoring and safety. In the Randomized Evaluation of Long Term Anticoagulant Therapy trial,1 dabigatran was shown to be as effective as warfarin in stroke prevention, with lower risk of major hemorrhage, opening the doors to this therapeutic possibility.
Prabhakaran S. Will Symptomatic Intracerebral Hemorrhages Decrease Among Eligible Dabigatran-Treated Patients Who Receive Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke?—Reply. Arch Neurol. 2010;67(9):1156-1157. doi:10.1001/archneurol.2010.206