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February 16, 2005

Oral Antiplatelet Therapy—Reply

JAMA. 2005;293(7):793-795. doi:10.1001/jama.293.7.794

In Reply: Dr Borja correctly points out that triflusal is another antiplatelet drug that has been demonstrated to be effective in vascular disease and was included in the Antithrombotic Trialists’ Collaboration Meta-analysis.1 In addition, triflusal appears to have similar efficacy when compared directly with aspirin in preventing recurrent vascular events in patients with acute MI and TIA or ischemic stroke.2,3 To our knowledge, triflusal is not currently available in North America and Australasia, and therefore it was not included in our critical review of direct comparisons of various antiplatelet regimens. Presumably for similar reasons, triflusal has not been included in the current guidelines from the American College of Chest Physicians.4 We agree that the benefit and safety profile of various antiplatelet therapies may not be of similar magnitude in patients with CAD, TIA/stroke, and peripheral arterial disease. Nevertheless, our recommendations are based on current available evidence. Ongoing trials will hopefully clarify whether there are differences in response to antiplatelet combinations across these 3 groups of patients with vascular disease.

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