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July 5, 2006

Medical Management of Peripheral Arterial Disease

Author Affiliations

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

JAMA. 2006;296(1):41-42. doi:10.1001/jama.296.1.41-b

To the Editor: In discussing medical treatment of PAD, Dr Hankey and colleagues1 state that “a meta-analysis of 8 [randomized controlled trials] involving 2702 patients demonstrated that cilostazol improved maximum walking distance and pain-free walking distance,” citing Thompson et al.2 However, in that study, the effect size was small, with increases of 50% and 67% in maximum walking distance and pain-free walking distance, respectively. Stated differently, if a patient could walk to first base before experiencing claudication, then with the addition of cilostazol, with its potential toxicity and at a cost in our pharmacy of $467.78 per month, he or she could round first and make it part of the way to second base.