Dabigatran: Important Considerations in the Elderly

We read, with keen interest, the report by Dezman et al. regarding the severity of bleeding and mortality in trauma patients taking dabigatran (1). Stroke physicians frequently prescribe non-vitamin K antagonist oral anticoagulants (NOAC) like dabigatran for stroke prevention in the context of nonvalvular atrial fibrillation. Although the introduction of NOAC into clinical practice has been a major advance with reduction of monitoring requirement, there remains ongoing concern about the risk of bleeding and the absence of an antidote. The NOAC randomized controlled trials have uniformly reported clinically significant reductions in intracranial hemorrhage (ICH) risk, but not gastrointestinal hemorrhage (2).