Letter by Stöllberger and Finsterer Regarding Article, “Intracranial Hemorrhage in Patients With Atrial Fibrillation During Anticoagulation With Warfarin or Dabigatran: The Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) Trial”

Abstract

To the Editor: We read with interest the article by Hart et al1 on intracranial hemorrhage (IH) in patients with atrial fibrillation undergoing anticoagulation treatment with warfarin or dabigatran. They analyzed retrospectively the clinical spectrum of 154 IHs in 18 113 participants of the Randomized Evaluation of Long-term anticoagulant therapY (RE-LY) trial and found that the rates of IHs were lower in dabigatran-treated patents than in those treated with warfarin. However, several points need to be addressed by the authors before one can accept the conclusion that dabigatran is indeed safer than warfarin with respect to the most feared complication of anticoagulant therapy, cerebral bleeding. In particular, the following questions need to be answered: How was it ascertained in the RE-LY study that the patients randomly chosen for the dabigatran group actually …