[Evaluation of regular physical activity in COPD patients with an accelerometer and a questionnaire: a pilot study].

the study by Modesto-Alapont et al,1 and it is therefore difficult to assess the true incidence of major and minor bleeding. Current guidelines of the International Society of Thrombosis and Haemostasis (ISTH) adopted by the European Medicines Agency (EMEA)6 recommend the following criteria to define major bleeding in nonsurgical patients: fatal bleeding, symptomatic bleeding in a critical area or organ, bleeding causing a fall in hemoglobin level of 20 g/L or more or leading to transfusion of 2 or more units of whole blood or red cells. The authors state in the conclusion that they “found a high prevalence of all types of bleeding.” However, in the abstract and results section they state that all bleeding complications were mild bleedings or subcutaneous hematomas. Therefore, we suspect that no major bleeding events occurred with bemiparin and that no differences in major bleeding were found in their study as compared to the control group, as reported in the literature.2 Finally, we think that, in this type of study, the reduction in VTE-related mortality should be weighed against a possible increase in deaths related to bleeding or other drug-related deaths, but not against an expected increase in mild bleeding or hematoma at the injection site. In conclusion, the study does not allow for drawing any relevant conclusion because of the abovementioned methodological weaknesses. There was a trend toward a lower mortality rate in patients receiving bemiparin that was not significant because of the inadequate sample size used and, as expected, there was a higher incidence of mild bleeding complications with no increase in major bleeding rates in patients treated with LMWH as compared to those receiving no treatment. Further studies with an appropriate sample size and methodology will be needed to address this issue.