Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
To the Editor: We are concerned about some
of the recommendations in the Clinical Review of oral antiplatelet agents
by Drs Tran and Anand1 that we believe are
inconsistent with clinical trial data and current clinical practice guidelines.
First, the use of combined aspirin and extended-release dipyridamole (ASA-ERDP)
in patients with concomitant symptomatic CAD is described as questionable,
due to a theoretical risk of coronary steal. The European Stroke Prevention
Study 2 trial of ASA-ERDP2 included more than
2000 patients with TIA or stroke and with coexisting CAD. No safety problems
with ERDP were noted in this population, and the 18% relative benefit of ASA-ERDP
over aspirin alone for prevention of stroke in this subgroup was consistent
with that observed in the overall trial3 ;
patients with cerebrovascular disease and a history of CAD who were treated
with ASA-ERDP had no increase in the risk of cardiac events compared with
patients treated with aspirin alone. We are aware of no clinical data to support
the avoidance of ASA-ERDP in patients with TIA or stroke and with coexisting
CAD and no evidence that any other antiplatelet options are more effective
for this patient subgroup.
Bernstein RA, Albers GW. Oral Antiplatelet Therapy. JAMA. 2005;293(7):793-795. doi:10.1001/jama.293.7.793-b