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Fixed-Dose Unfractionated Heparin vs Low-Molecular-Weight Heparin for Venous Thromboembolism—Reply
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In Reply: In response to Dr Bhala and colleagues, the definition of major bleeding that we used is standard for studies of VTE, and we believe that blood loss equivalent to 2 units is clinically important.1 Bleeding that was considered abnormal (ie, more than trivial) but that did not satisfy criteria for major bleeding was classified as "minor." Intracranial and fatal bleeds were described in the article; the remaining major bleeding episodes were intra-articular (n = 2), genitourinary (n = 1), gastrointestinal (n = 1), and retroperitoneal (n = 1) in the unfractionated heparin group and gastrointestinal (n = 6), intra-articular (n = 2), and from a surgical site (n = 1) in the low-molecular-weight heparin group.
Regarding the concerns of Drs Zhan and Zheng, men do appear to have a somewhat higher risk of recurrent VTE than women after treatment is stopped.2 However, we are not aware of such an association during either acute or long-term anticoagulant therapy. Randomization resulted in a very . . . [Full Text of this Article]
Clive Kearon, MB, PhD
kearonc@mcmaster.ca
Jeffrey S. Ginsberg, MD;
Jim A. Julian, MMath;
Michael Gent, DSc
McMaster University
Hamilton, Ontario
for the Fixed-Dose Heparin (FIDO) Investigators
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Comparison of Fixed-Dose Weight-Adjusted Unfractionated Heparin and Low-Molecular-Weight Heparin for Acute Treatment of Venous Thromboembolism
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