Be careful to use Dabigatran

As we have recently written, the benefit of Dabigatran as protection against stroke in patients with atrial fibrillation needs to be weighed against a significant (28%) increase in the risk of serious and sometimes fatal bleeding, myocardial infarction and acute coronary syndrome. A review of a number of recent studies showed this to be true across a broad spectrum of patients, especially in the elderly and patients with renal dysfunction:


  1. Dabigatran Association With Higher Risk of Acute Coronary Events, Ken Uchino, MD; Adrian V. Hernandez, MD, PhD, Arch Intern Med, Vol 172: 397-402.
  2. Legrand M, Mateo J, Aribaud A, et al. The use of dabigatran in elderly patients. Arch Intern Med 2011; 171:1285-1288. 
  3. Jacobs JM and Stessman J. New anticoagulant drugs among elderly patients. Is caution necessary?  Arch Intern Med 2011; 171:1287-1288.