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Major bleeds ‘less critical’ with dabigatran than with warfarin

Major bleeds in patients taking dabigatran tend to be less critical and more manageable than those in patients taking warfarin, suggests a new meta-analysis published in Circulation.

The data also seems to suggest major bleeding events were no more common with the newer oral anticoagulant and tended to occur in higher-risk patients

The meta-analysis was based on pooled patient-level data from the atrial fibrillation trial RE-LY and the VTE-prevention trials RECOVER, RECOVER II, RE-MEDY and RESONATE, which altogether saw 1121 major bleeds in over 27 000 patients. Major bleeds included only those developing within three days of the last dose of anticoagulant.

The researchers’ conclusions included:

- the 30-day mortality after the first major bleed tended to be 32% lower in the dabigatran group at 9.1% compared to 13% in the warfarin group

patients who experienced a bleed while taking dabigatran had a mean stay in ICU of 1.6 nights compared with 2.7 nights for those taking warfarin.

The authors say the differences could be at least in part due to the fact that the worst major bleeds tended to be gastrointestinal with dabigatran but intracranial with warfarin.

For a detailed look at the evidence on the new oral antocoaulants read Analysis: Can warfarin alternatives fulfil their promise? Pulse 1st October



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