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Comment & Response |

Patient Characteristics and Risk of Bleeding With Dabigatran in Atrial Fibrillation

Daniel Pilsgaard Henriksen, MD, PhD1; Morten Rix Hansen, MD2; Per Damkier, MD, PhD1
[+] Author Affiliations
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.
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To the Editor We appreciate the interesting study by Hernandez et al1 on the risk of bleeding with dabigatran in patients with atrial fibrillation. These are important data to an ongoing controversy. However, we would appreciate an author comment regarding the external validity of the study. To what extent is this sample of Medicare beneficiaries representative of the general population of patients with atrial fibrillation? Comparing the characteristics of patients in the RE-LY Study2 and the Danish population-based study,3 it seems that these are not effortlessly comparable. In the study by Hernandez et al,1 patients are considerably older (average age, 76 years) than patients in the RE-LY study or the Danish study (average ages, 72 and 70 years, respectively). Notably, the frequency of coadministration of antiplatelet drugs was 8% in the current study compared with 40% in both the RE-LY and the Danish population data. From the distribution of CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism) scores across these studies, it seems that a substantial proportion of Medicare recipients are at lower risk than those reported in the other 2 articles.

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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
Deborah L. Horjus, MD; Gert A. van Montfrans, MD, PhD; Lizzy M. Brewster, MD, PhD
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.
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
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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