Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
In Reply: Although the objective of our study
was not to evaluate the intracoronary use of Gp IIb/IIIa inhibitors but to
test the time factor of these drugs used with the same dose regimen and the
same IV route of administration, Dr Horton raises an interesting question
that is of significant importance to the interventional cardiologist. Case
reports and case series have shown that the intracoronary use of Gp IIb/IIIa
inhibitors (mainly abciximab) is feasible and certainly effective. However,
it is important to acknowledge the serious limitations of these evaluations:
(1) small numbers of patients compared with the larger population we reported;
(2) different dose regimens used in these studies; (3) different techniques
of administration either upstream of the thrombus (in the guiding catheter)
or downstream after crossing the lesion; and (4) no randomized evaluation
of the clinical impact of intracoronary vs IV administration.
Montalescot G, Borentain M, Payot L, Collet JP, Thomas D. Glycoprotein IIb/IIIa Inhibition—Reply. JAMA. 2004;292(18):2211-2212. doi:10.1001/jama.292.18.2211-c