The fact that many doctors still refuse to replace the anticoagulant warfarin with dabigatran, despite dabigatran’s better safetyprofile, is not a scientific problem but a psychological one. In my view there are four fears in doctors’ minds:
1) Fear of dabigatran’s hidden higher incidence of bleeding.
2) Fear of bleeding crisis when dabigatran’s antidote is not available.
3) Fear of overdose in Thai population when extrapolating the dose from Caucasian population.
4) Fear of higher cost for patients.
I address these four fears one by one below.