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Comment & Response
May 2017

Dabigatran Compared With Rivaroxaban vs Warfarin

Author Affiliations
  • 1University of California, San Francisco, San Francisco
JAMA Intern Med. 2017;177(5):741-742. doi:10.1001/jamainternmed.2017.0554

To the Editor In a recent issue of JAMA Internal Medicine, Graham et al1 reported that rivaroxaban use increased risks of major bleeding with nonsignificant reduction in thromboembolic stroke and increased mortality compared with dabigatran in elderly Medicare beneficiaries newly treated with dabigatran or rivaroxaban for nonvalvular atrial fibrillation (November 2011-June 2014).1 However, dabigatran event rates were lower than reported by Graham et al1 in a larger group of elderly Medicare beneficiaries newly treated with dabigatran or warfarin for nonvalvular atrial fibrillation with longer follow-up during a partially overlapping period (October 2010-December 2012).2 Incidence rates per 1000 person-years for dabigatran when compared with rivaroxaban vs warfarin were 26.6 vs 42.7 for major hemorrhage, 23.3 vs 34.2 for gastrointestinal hemorrhage, 12.9 vs 15.7 for acute myocardial infarction, and 22.2 vs 32.6 for mortality.1,2 The marked differences in dabigatran event rates could have possible explanations but raise concerns.

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