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Dabigatran and Bleeding Risks in Older Patients

Elaine Hylek, MD, Professor of Medicine at Boston University discusses the risks of major bleeding with dabigatran, particularly in patients with atrial fibrillation. These patients are typically older; approximately 10-12% over age 80 have atrial fibrillation. The most common clinical problem with this age group is balancing the increasing risk of stroke with the accompanying increased risk of bleeding. Trials such as the RELY trial have shown a dramatically decreased risk of intracranial hemorrhage (ICH) and other major bleeding with dabigatran in these patients. For the management of bleeding with dabigatran, supportive therapy is often sufficient due to the relatively short half-life of approximately 10 hours (with good renal function). If necessary in the case of life-threatening bleeding, prothrombin complex concentrates (PCC’s) are likely the agent of first choice, and the data on new reversal agents is also very promising.