Resuming anticoagulation after hemorrhage

Article Type
Changed
Wed, 09/13/2017 - 09:41
Display Headline
Resuming anticoagulation after hemorrhage

To the Editor: I read with great interest the article “Resuming anticoagulation after hemorrhage: A practical approach.”1 The article was very well written and thorough, and the authors did a great job discussing such a controversial topic.

For the sake of completeness, I would like to point out another available option when it comes to warfarin-related bleeding. We have two studies so far. Although the results were contradicting in some ways, the Prevention of Recurrent Venous Thromboembolism (PREVENT)2 and Extended Low-Intensity Anticoagulation for Thromboembolism (ELATE)3 trials shed light on the possible value of low-intensity anticoagulation (international normalized ratio 1.5–2.0) beyond the conventional treatment period for prevention of recurrent venous thromboembolism. While the PREVENT trial found a lower rate of venous thromboembolism with low-intensity anticoagulation than with placebo without increasing the risk of major bleeding, the ELATE trial found no difference in bleeding rates between low-intensity and conventional treatment.

To put this in perspective, I believe that low-intensity anticoagulation is still an option for patients with moderate-risk indications and low to moderate bleeding risk.

It will be interesting to see how lower-intensity dosing of the newer anticoagulants will perform in a similar setting.

References
  1. Colantino A, Jaffer AK, Brotman DJ. Resuming anticoagulation after hemorrhage: a practical approach. Cleve Clin J Med 2015; 82:245–256.
  2. Ridker PM, Goldhaber SZ, Danielson E, et al; PREVENT Investigators. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med 2003; 348:1425–1434.
  3. Kearon C, Ginsberg JS, Kovacs MJ, et al; Extended Low-Intensity Anticoagulation for Thrombo-Embolism Investigators. Comparison of low-intensity warfarin therapy with conventional-intensity warfarin therapy for long-term prevention of recurrent venous thromboembolism. N Engl J Med 2003; 349:631–639.
Article PDF
Author and Disclosure Information

Mohamad Badr Jandali, MD
West Bloomfield, MI

Issue
Cleveland Clinic Journal of Medicine - 82(10)
Publications
Topics
Page Number
639-640
Legacy Keywords
anticoagulation, warfarin, hemorrhage, PREVENT trial, ELATE trial, Mohamad Jandali
Sections
Author and Disclosure Information

Mohamad Badr Jandali, MD
West Bloomfield, MI

Author and Disclosure Information

Mohamad Badr Jandali, MD
West Bloomfield, MI

Article PDF
Article PDF
Related Articles

To the Editor: I read with great interest the article “Resuming anticoagulation after hemorrhage: A practical approach.”1 The article was very well written and thorough, and the authors did a great job discussing such a controversial topic.

For the sake of completeness, I would like to point out another available option when it comes to warfarin-related bleeding. We have two studies so far. Although the results were contradicting in some ways, the Prevention of Recurrent Venous Thromboembolism (PREVENT)2 and Extended Low-Intensity Anticoagulation for Thromboembolism (ELATE)3 trials shed light on the possible value of low-intensity anticoagulation (international normalized ratio 1.5–2.0) beyond the conventional treatment period for prevention of recurrent venous thromboembolism. While the PREVENT trial found a lower rate of venous thromboembolism with low-intensity anticoagulation than with placebo without increasing the risk of major bleeding, the ELATE trial found no difference in bleeding rates between low-intensity and conventional treatment.

To put this in perspective, I believe that low-intensity anticoagulation is still an option for patients with moderate-risk indications and low to moderate bleeding risk.

It will be interesting to see how lower-intensity dosing of the newer anticoagulants will perform in a similar setting.

To the Editor: I read with great interest the article “Resuming anticoagulation after hemorrhage: A practical approach.”1 The article was very well written and thorough, and the authors did a great job discussing such a controversial topic.

For the sake of completeness, I would like to point out another available option when it comes to warfarin-related bleeding. We have two studies so far. Although the results were contradicting in some ways, the Prevention of Recurrent Venous Thromboembolism (PREVENT)2 and Extended Low-Intensity Anticoagulation for Thromboembolism (ELATE)3 trials shed light on the possible value of low-intensity anticoagulation (international normalized ratio 1.5–2.0) beyond the conventional treatment period for prevention of recurrent venous thromboembolism. While the PREVENT trial found a lower rate of venous thromboembolism with low-intensity anticoagulation than with placebo without increasing the risk of major bleeding, the ELATE trial found no difference in bleeding rates between low-intensity and conventional treatment.

To put this in perspective, I believe that low-intensity anticoagulation is still an option for patients with moderate-risk indications and low to moderate bleeding risk.

It will be interesting to see how lower-intensity dosing of the newer anticoagulants will perform in a similar setting.

References
  1. Colantino A, Jaffer AK, Brotman DJ. Resuming anticoagulation after hemorrhage: a practical approach. Cleve Clin J Med 2015; 82:245–256.
  2. Ridker PM, Goldhaber SZ, Danielson E, et al; PREVENT Investigators. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med 2003; 348:1425–1434.
  3. Kearon C, Ginsberg JS, Kovacs MJ, et al; Extended Low-Intensity Anticoagulation for Thrombo-Embolism Investigators. Comparison of low-intensity warfarin therapy with conventional-intensity warfarin therapy for long-term prevention of recurrent venous thromboembolism. N Engl J Med 2003; 349:631–639.
References
  1. Colantino A, Jaffer AK, Brotman DJ. Resuming anticoagulation after hemorrhage: a practical approach. Cleve Clin J Med 2015; 82:245–256.
  2. Ridker PM, Goldhaber SZ, Danielson E, et al; PREVENT Investigators. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med 2003; 348:1425–1434.
  3. Kearon C, Ginsberg JS, Kovacs MJ, et al; Extended Low-Intensity Anticoagulation for Thrombo-Embolism Investigators. Comparison of low-intensity warfarin therapy with conventional-intensity warfarin therapy for long-term prevention of recurrent venous thromboembolism. N Engl J Med 2003; 349:631–639.
Issue
Cleveland Clinic Journal of Medicine - 82(10)
Issue
Cleveland Clinic Journal of Medicine - 82(10)
Page Number
639-640
Page Number
639-640
Publications
Publications
Topics
Article Type
Display Headline
Resuming anticoagulation after hemorrhage
Display Headline
Resuming anticoagulation after hemorrhage
Legacy Keywords
anticoagulation, warfarin, hemorrhage, PREVENT trial, ELATE trial, Mohamad Jandali
Legacy Keywords
anticoagulation, warfarin, hemorrhage, PREVENT trial, ELATE trial, Mohamad Jandali
Sections
Disallow All Ads
Alternative CME
Article PDF Media