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Comment & Response |

Bleeding in Patients of African Ancestry Using Dabigatran A Potential Effect of Creatine Kinase

Deborah L. Horjus, MD1; Gert A. van Montfrans, MD, PhD2; Lizzy M. Brewster, MD, PhD1
[+] Author Affiliations
1Department of Vascular, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
2Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
JAMA Intern Med. 2015;175(7):1243. doi:10.1001/jamainternmed.2015.1274.
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To the Editor Hernandez et al1 reported that dabigatran was associated with a higher incidence of major bleeding than warfarin, particularly in patients of African ancestry. However, the authors did not offer an explanation for this important clinical observation. We propose that high plasma creatine kinase (CK) levels, commonly seen in patients of African ancestry, can potentially have an effect on the direct thrombin inhibitor dabigatran, increasing bleeding risk.

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July 1, 2015
Marta A. Miyares, PharmD, BCPS (AQ Cardiology), CACP
1Pharmacy Department, Jackson Memorial Hospital, Miami, Florida
JAMA Intern Med. 2015;175(7):1242-1243. doi:10.1001/jamainternmed.2015.1271.
July 1, 2015
Adi Klil-Drori, MD; Laurent Azoulay, PhD
1Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada2Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
1Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada3Department of Oncology, McGill University, Montreal, Quebec, Canada
JAMA Intern Med. 2015;175(7):1243-1244. doi:10.1001/jamainternmed.2015.1277.
July 1, 2015
Kristina Zint, PhD; Jörg Kreuzer, MD
1Boehringer Ingelheim GmbH & Co KG, Ingelheim am Rhein, Germany
JAMA Intern Med. 2015;175(7):1244. doi:10.1001/jamainternmed.2015.1280.
July 1, 2015
Siyao Liu, BSc; Cherub O. Kim, MSc; Scott N. Lucyk, MD
1New York University School of Medicine, New York
2Division of Medical Toxicology, New York University School of Medicine, New York
JAMA Intern Med. 2015;175(7):1244-1245. doi:10.1001/jamainternmed.2015.1286.
July 1, 2015
Daniel Pilsgaard Henriksen, MD, PhD; Morten Rix Hansen, MD; Per Damkier, MD, PhD
1Department of Clinical Chemistry and Pharmacology, Odense University Hospital, Odense, Denmark
2Research Unit of Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark
JAMA Intern Med. 2015;175(7):1245. doi:10.1001/jamainternmed.2015.1289.
July 1, 2015
Inmaculada Hernandez, PharmD; Yuting Zhang, PhD
1Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA Intern Med. 2015;175(7):1245-1247. doi:10.1001/jamainternmed.2015.1299.
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