IN RESPONSE: We agree that the risk for major bleeding events is highest shortly after initiation of anticoagulant therapy, particularly in the first 3 months of treatment. However, the patient population of our meta-analysis was composed of those with a first unprovoked venous thromboembolism who had already completed at least 3 to 6 months of initial anticoagulation.
Although we acknowledge the concern about potential “depletion of susceptibles bias” (that is, bleeding events becoming less frequent over longer periods of time), results from our meta-analysis do not suggest that is the case. As shown in our analysis among patients receiving extended ...
Author, Article, and Disclosure Information
University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Ottawa Hospital Research Institute, University of Ottawa, and The Ottawa Hospital, Ottawa, Ontario, Canada
University of Ottawa, Ottawa Hospital Research Institute, and The Ottawa Hospital, Ottawa, Ontario, Canada
Ottawa Hospital Research Institute, Ottawa, Ontario, and McGill University, Montreal, Quebec, Canada
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-1094.