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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.
- Colantino A, Jaffer AK, Brotman DJ. Resuming anticoagulation after hemorrhage: a practical approach. Cleve Clin J Med 2015; 82:245–256.
- 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.
- 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.
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.
- Colantino A, Jaffer AK, Brotman DJ. Resuming anticoagulation after hemorrhage: a practical approach. Cleve Clin J Med 2015; 82:245–256.
- 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.
- 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.
- Colantino A, Jaffer AK, Brotman DJ. Resuming anticoagulation after hemorrhage: a practical approach. Cleve Clin J Med 2015; 82:245–256.
- 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.
- 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.