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November 10, 2004

Glycoprotein IIb/IIIa Inhibition—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(18):2211-2212. doi:10.1001/jama.292.18.2211-c

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.