Russell D. Hull, MBBS; the EXCLAIM Steering Committee
Potential Conflicts of Interest: Disclosures for the authors of the EXCLAIM study can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M09-0393.
Hull R., ; Extended-Duration Venous Thromboembolism Prophylaxis for Medical Patients. Ann Intern Med. 2010;153:689-690. doi: 10.7326/0003-4819-153-10-201011160-00021
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Published: Ann Intern Med. 2010;153(10):689-690.
We thank Dr. Dentali and colleagues for highlighting bleeding risk as a key factor in the decision to provide extended-duration anticoagulant prophylaxis. Stratification of patients according to bleeding risk would enable clinicians to clearly identify patients who are more likely to have hemorrhagic complications. Because few major bleeding events occurred in the study (n = 35), we cannot accurately develop a predictive model. The EXCLAIM study demonstrated an increased risk for bleeding events in patients who received antiplatelet therapy. This population also had higher VTE event rates than did patients who did not receive antiplatelet therapy (31 of 324 [9.6%] vs. 130 of 4671 [2.8%]; P < 0.001). However, we recommend cautious interpretation of these results because the medical characteristics of these 2 populations may vary greatly and result in different baseline risk for VTE and bleeding.
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