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To the Editor: Dr Kearon and colleagues¹ compared the use of fixed-dose, weight-adjusted unfractionated heparin and low-molecular-weight heparin for acute venous thromboembolism (VTE). One of the key findings was the small risk of major bleeding at 10 days, although there was a non–statistically significant difference at 3 months (1.7% for the unfractionated heparin group vs 3.4% for the low-molecular-weight heparin group).

We believe that the definitions of bleeding are too heterogeneous and that further clarification of the underlying etiology of the bleeding is required. In this study, bleeding was defined as major if it was clinically overt and associated with a decrease in hemoglobin level of at least 2.0 g/dL, involved a need for transfusion of 2 or more units of red blood cells, or involved a critical site (eg, retroperitoneal, intracranial). These are less stringent criteria than the TIMI classification,² which requires a decrease in hemoglobin of more than . . . [Full Text of this Article]

Neeraj Bhala, MRCP
nijbhala@doctors.org.uk

Ashit Shah, MRCP; Andrew King, MRCP; Chakri Molugu, MRCP
Department of Gastroenterology
University Hospital of Coventry & Warwick
Walsgrave, Coventry, England

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