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To the Editor: Dr Steinhubl and colleagues¹ found that following PCI with clopidogrel therapy, in addition to traditional aspirin therapy, significantly reduced the likelihood of adverse events at 1 year. They also found that a loading dose of clopidogrel at least 3 hours prior to the procedure did not reduce events at 28 days, but that a loading dose of clopidogrel at least 6 hours prior to PCI may offer some benefit.

The study raises methodological questions associated with the evaluation of multiple interventions. It is not clear how many different interventions can be studied in a single trial.² Steinhubl et al, however, evaluated at least 2 interventions (long-term use and loading dose of clopidogrel) in addition to the already existing therapy of aspirin (a potential third). The number of interventions increases if one draws a distinction between loading doses given 3 to 6 hours prior and 6 to 24 . . . [Full Text of this Article]

John F. P. Bridges, PhD
Health Services Research Division
Case Western Reserve University
Cleveland, Ohio

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