In reply: O’Reilly and colleagues belatedly address the need to consider bleeding risk and costs when choosing between management routines designed to prevent venous thrombosis and pulmonary embolism. Their otherwise valuable article1 failed to record bleeding rates when patients (almost 17%) with subclinical calf-vein thrombosis were exposed to therapeutic (not prophylactic) anticoagulant dosages. Nor did they evaluate the dollar and manpower costs of their complex management routines.
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The author has received consulting fees for participating in clinical trial steering committees (from Sanofi, Bristol-Myers Squibb, Bayer and Organon) and expert committees (from AstraZeneca, Bayer and CSL).