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February 16, 2005

Oral Antiplatelet Therapy

JAMA. 2005;293(7):793-795. doi:10.1001/jama.293.7.793-b

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.

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