In Reply: We agree with the comments by Dr Huang and colleagues. Our principal findings were the association of both bivalirudin and vascular closure devices with lower rates of periprocedural bleeding, and the apparent risk-treatment paradox with regard to individual preprocedure bleeding risk and use of these therapies in clinical practice. Because this was an observational study of clinical registry data, we attempted to avoid causal language in describing the association between the use of vascular closure devices and bivalirudin with periprocedural bleeding throughout the article.
Marso SP, House JA, Rumsfeld JS. Bleeding Avoidance Strategies and Percutaneous Coronary Intervention—Reply. JAMA. 2010;304(10):1068-1069. doi:10.1001/jama.2010.1256