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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: We believe that the study by Dr Ost and colleagues¹ of duration of anticoagulation following venous thromboembolism is missing important data on bleeding risk that are needed for clinicians and patients to make fully informed decisions about how long to continue secondary prophylaxis.

Randomized trials often report lower bleeding rates than do studies of community outpatients.² This discrepancy may be due to closer monitoring of international normalized ratio, better education of participants about food and drug interactions, or stringent participant selection.³ The appropriate incidence rate ratio for bleeding is not one pooled from clinical trials, but from epidemiologic studies, which are lacking. As a surrogate, if rates of major bleeding are 0.4% per year without warfarin,⁴ and 1% per year⁴ to 7.22% per year³ with warfarin, the number needed to harm with 1 additional year of anticoagulation may be approximately 14 to 167. Alternatively, clinicians could identify . . . [Full Text of this Article]

Elizabeth Krakow, MD, CM
elizabeth.krakow@duke.edu

Thomas L. Ortel, MD, PhD
Duke University Medical Center
Durham, NC

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