Periprocedural Bleeding and Thromboembolic Events With Dabigatran Compared With Warfarin: Results From the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) Randomized Trial

• Published in: Circulation (New York, N.Y.) Vol. 126; no. 3; pp. 343 - 348
• Main Authors: HEALEY, Jeff S, EIKELBOOM, John, CONNOLLY, Stuart J, YUSUF, Salim, EZEKOWITZ, Michael, DOUKETIS, James, WALLENTIN, Lars, OLDGREN, Jonas, YANG, Sean, THEMELES, Ellison, HEIDBUCHLE, Hein, AVEZUM, Alvaro, REILLY, Paul
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 17.07.2012
• Subjects: Aged; Aged, 80 and over; anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; atrial fibrillation; Benzimidazoles - administration & dosage; Benzimidazoles - adverse effects; beta-Alanine - administration & dosage; beta-Alanine - adverse effects; beta-Alanine - analogs & derivatives; Biological and medical sciences; Blood and lymphatic vessels; Blood Loss, Surgical - prevention & control; Blood. Blood coagulation. Reticuloendothelial system; Brain Ischemia - prevention & control; Cardiac Pacing, Artificial - adverse effects; Cardiology. Vascular system; Cataract Extraction - adverse effects; Dabigatran; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; Hemorrhage - chemically induced; Hemorrhage - epidemiology; Hemorrhage - prevention & control; Humans; Incidence; Male; Medical sciences; Middle Aged; perioperative; Pharmacology. Drug treatments; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Risk Factors; Stroke - prevention & control; stroke prevention; surgery; Thromboembolism - drug therapy; Thromboembolism - epidemiology; Warfarin - administration & dosage; Warfarin - adverse effects; Arrhythmia; Coumarine derivatives; Thrombin; Cardiovascular disease; Anticoagulant; Dabigatran; Antithrombin; Hemorrhage; Vascular disease; Prevention; Antivitamin K; Heart disease; Surgery; Antithrombotic agent; anticoagulants; Thromboembolism; Cerebrovascular disease; Nervous system diseases; Stroke; Warfarin; Serine endopeptidases; Enzyme; Atrial fibrillation; Enzyme inhibitor; Thrombosis; Excitability disorder; Embolism; Cerebral disorder; Peptidases; perioperative; Treatment; Central nervous system disease; Hydrolases; stroke prevention
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.111.090464

Dabigatran reduces ischemic stroke in comparison with warfarin; however, given the lack of antidote, there is concern that it might increase bleeding when surgery or invasive procedures are required. The current analysis was undertaken to compare the periprocedural bleeding risk of patients in the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial treated with dabigatran and warfarin. Bleeding rates were evaluated from 7 days before until 30 days after invasive procedures, considering only the first procedure for each patient. A total of 4591 patients underwent at least 1 invasive procedure: 24.7% of patients received dabigatran 110 mg, 25.4% received dabigatran 150 mg, and 25.9% received warfarin, P=0.34. Procedures included: pacemaker/defibrillator insertion (10.3%), dental procedures (10.0%), diagnostic procedures (10.0%), cataract removal (9.3%), colonoscopy (8.6%), and joint replacement (6.2%). Among patients assigned to either dabigatran dose, the last dose of study drug was given 49 (35-85) hours before the procedure on comparison with 114 (87-144) hours in patients receiving warfarin, P<0.001. There was no significant difference in the rates of periprocedural major bleeding between patients receiving dabigatran 110 mg (3.8%) or dabigatran 150 mg (5.1%) or warfarin (4.6%); dabigatran 110 mg versus warfarin: relative risk, 0.83; 95% CI, 0.59 to 1.17; P=0.28; dabigatran 150 mg versus warfarin: relative risk, 1.09; 95% CI, 0.80 to 1.49; P=0.58. Among patients having urgent surgery, major bleeding occurred in 17.8% with dabigatran 110 mg, 17.7% with dabigatran 150 mg, and 21.6% with warfarin: dabigatran 110 mg; relative risk, 0.82; 95% CI, 0.48 to 1.41; P=0.47; dabigatran 150 mg: relative risk, 0.82; 95% CI, 0.50 to 1.35; P=0.44. Dabigatran and warfarin were associated with similar rates of periprocedural bleeding, including patients having urgent surgery. Dabigatran facilitated a shorter interruption of oral anticoagulation. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00262600.