We do not know the pharmacologic mechanism that may result in dabigatran increasing the risk of MI or ACS.

The development of another direct thrombin inhibitor, ximelagatran, was halted when a higher risk of increase in hepatic transaminase levels was observed.

Although the anticoagulant property of ximelagatran may reduce cardiovascular events, it was found to increase some proinflammatory markers.

Thus, as a member of the same drug class, dabigatran might have effects that are unfavorable to atherosclerosis or atherosclerotic thrombotic events.

JAMA Network | Archives of Internal Medicine | Dabigatran Association With Higher Risk of Acute Coronary EventsMeta-analysis of Noninferiority Randomized Controlled Trials
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