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To the Editor: The report of the OASIS-6 trial by Yusuf and colleagues¹ showed improved survival and a tendency toward decreased severe bleeding in patients treated with the factor Xa inhibitor fondaparinux compared with unfractionated heparin (UFH) therapy. These results appear even more positive when compared with another recent trial that found increased severe bleeding with enoxaparin in ST-segment elevation myocardial infarction.²

Bleeding leads to increased mortality risk³ and should be avoided. However, among studies there is heterogeneity in the definition of severe bleeding, which includes both clinically overt hemorrhage associated with a drop in hemoglobin of more than 5 g/dL (implying gastrointestinal loss) and intracranial bleeding. In the OASIS-6 trial, 61 patients treated with fondaparinux vs 79 patients treated with placebo (or UFH) experienced severe bleeds as defined by modified Thrombolysis in Myocardial Infarction (TIMI) criteria.⁴ Of these, 11 and 10 respectively were classified as intracranial events. Another 46 . . . [Full Text of this Article]

Neeraj Bhala, MBChB, MRCP
nijbhala@doctors.org.uk
Department of Gastroenterology
Walsgrave Hospital
University Hospitals of Coventry & Warwick
Coventry, England

Praveen Rajasekhar, BSc, MBChB; Iain Moore, MBChB, MRCP
Department of Medicine
Sunderland Royal Hospital
Sunderland, England

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