Both the SELECT-D and Hokusai trials found a small increase in bleeding risk with similar primary outcomes with the use of DOAC compared to LMWH. As was mentioned in the AVERT paper, there are obvious challenges to the use of outpatient LMWH for prophylaxis, but it certainly is possible and there are other conditions for which we routinely use it. Would you see any particular value in investigating LMWH vs DOAC as high-risk prophylaxis, or, given that studies have shown they achieve similar results, would you consider the pragmatic superiority of DOAC therapy to outweigh a small increase in bleeding risk?
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