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
Tran H, Anand SS. Oral Antiplatelet Therapy—Reply. JAMA. 2005;293(7):793–795. doi:10.1001/jama.293.7.794
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