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To the Editor: In their randomized trial of acute treatment of VTE, Dr Kearon and colleagues¹ concluded that fixed-dose, unmonitored, subcutaneous unfractionated heparin is as effective and safe as fixed-dose, unmonitored, subcutaneous low-molecular-weight heparin. We are concerned about this conclusion.

First, studies have shown that the risk of recurrent VTE is higher among men than women; in some studies, the risk of recurrence was almost 4 times greater in men compared with women.^2-3 In Kearon et al, the unfractionated heparin group had a greater proportion of female patients than did the low-molecular-weight heparin group (173 [49%] vs 147 [42%]). The authors did not adjust for the sex difference in their statistical analysis of efficacy. Sex-related difference in the risk of recurrence has to be taken into account in the interpretation of outcome events.

Second, most recurrent VTE events occur between 3 months and 2 years after the first episode.⁴ In . . . [Full Text of this Article]

Huichun Zhan, MD, MS
hczhanmd@yahoo.com

Haoyi Zheng, MD, PhD
Department of Medicine
Long Island Jewish Medical Center
Albert Einstein College of Medicine
New Hyde Park, NY

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