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October 12, 2005

Abciximab in the Treatment of ST-Segment Elevation Myocardial Infarction—Reply

JAMA. 2005;294(14):1760-1761. doi:10.1001/jama.294.14.1761-a

In Reply: We agree with Dr Tan and colleagues that the use of low-molecular-weight heparin has the potential to be a confounding factor in our meta-analysis, particularly in the results of trials with thrombolysis, whereas unfractionated heparin was used in all primary angioplasty trials. However, we believe that actual confounding is unlikely. The support for this hypothesis comes from a post hoc observation of a small trial (ENTIRE-TIMI 23),1 whereas the largest trial included in the meta-analysis (GUSTO V)2 showed that in patients treated with unfractionated heparin, combination therapy does not give any additional benefit in terms of mortality. Furthermore, no data on the comparison between thrombolysis plus abciximab in patients receiving unfractionated heparin vs low-molecular-weight heparin have been reported in the ASSENT-3 trial.3 Finally, in our study we analyzed death and reinfarction as separate end points, whereas the data cited from the ENTIRE-TIMI 23 trial1 are based on a combined end point of death, reinfarction, or both.

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