Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: Dr Hackam disagrees with our conclusion that aspirin is the preferred antiplatelet drug for PAD, citing randomized studies of clopidogrel1 and picotamide2 to suggest that these agents are more effective than aspirin. The CAPRIE trial was designed to compare the effectiveness and safety of clopidogrel and aspirin in patients at high vascular risk and showed that clopidogrel is marginally but significantly more effective than aspirin in preventing myocardial infarction, stroke, or death in all patients with high vascular risk (relative risk reduction [RRR], 8.7%; 95% CI, 0.3%-16.5%; P = .04). The study was not designed or powered to provide reliable conclusions about the effectiveness and safety of clopidogrel and aspirin in patients with PAD.
Eikelboom J, Hankey G, Norman P. Medical Management of Peripheral Arterial Disease—Reply. JAMA. 2006;296(1):41-42. doi:10.1001/jama.296.1.41-c