Letter by Hjemdahl et al regarding article, "Periprocedural bleeding and thromboembolic events with dabigatran compared with warfarin: results from the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) Randomized Trial".

To the Editor: We read with interest the report by Healy and coworkers1 on periprocedural bleeding and thromboembolic events in the RE-LY trial, which indicates that 10% to 15% of atrial fibrillation patients on oral anticoagulants may need a surgical operation or other invasive procedure annually. There is concern in these situations about how to avoid and how to manage serious bleeds during anticoagulant treatment, especially with new oral anticoagulants such as dabigatran, which lacks a specific antidote.2–4 It is difficult to evaluate the intensity of anticoagulation in dabigatran-treated patients. Routinely used coagulation tests such as the activated partial thromboplastin time are not sufficiently reliable. More specific tests (ecarin …