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Comment & Response
July 2015

The Role of Selection in the Risk of Bleeding With Dabigatran in Patients With Atrial Fibrillation

Author Affiliations
  • 1Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
  • 2Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
  • 3Department of Oncology, McGill University, Montreal, Quebec, Canada
JAMA Intern Med. 2015;175(7):1243-1244. doi:10.1001/jamainternmed.2015.1277

To the Editor We read with interest the study by Hernandez et al1 regarding the risk of bleeding with dabigatran vs warfarin in patients with atrial fibrillation (AF). Using the Medicare population, the authors reported that dabigatran was associated with an increased risk of major bleeding compared with warfarin (hazard ratio [HR], 1.58; 95% CI, 1.36-1.83). In contrast, both the RE-LY randomized controlled trial2 and a recent observational study by Graham et al3 (also using the Medicare population) did not observe an increased risk of major bleeding with dabigatran compared with warfarin (HR, 0.93; 95% CI, 0.81-1.07, and HR, 0.97; 95% CI, 0.88-1.07, respectively).

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