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Resuming anticoagulation after hemorrhage

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To the Editor: I read with great interest the article “Resuming anticoagulation after hemorrhage: A practical approach.”1 The article was very well written and thorough, and the authors did a great job discussing such a controversial topic.

For the sake of completeness, I would like to point out another available option when it comes to warfarin-related bleeding. We have two studies so far. Although the results were contradicting in some ways, the Prevention of Recurrent Venous Thromboembolism (PREVENT)2 and Extended Low-Intensity Anticoagulation for Thromboembolism (ELATE)3 trials shed light on the possible value of low-intensity anticoagulation (international normalized ratio 1.5–2.0) beyond the conventional treatment period for prevention of recurrent venous thromboembolism. While the PREVENT trial found a lower rate of venous thromboembolism with low-intensity anticoagulation than with placebo without increasing the risk of major bleeding, the ELATE trial found no difference in bleeding rates between low-intensity and conventional treatment.

To put this in perspective, I believe that low-intensity anticoagulation is still an option for patients with moderate-risk indications and low to moderate bleeding risk.

It will be interesting to see how lower-intensity dosing of the newer anticoagulants will perform in a similar setting.

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