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To the Editor: Dr Lincoff and colleagues¹ reported that patients who received bivalirudin with provisional glycoprotein IIb/IIIa (Gp IIb/IIIa) blockade after percutaneous coronary intervention (PCI) had a risk of acute ischemic events similar to that of those who received heparin plus planned Gp IIb/IIIa blockade. They also reported that bivalirudin was associated with less bleeding. We have 2 concerns, however, about the generalizability of these results.

First, the protocol excluded patients with acute myocardial infarction. Such patients often have a large amount of thrombus burden in the coronary artery with risk of distal embolization, and thus Gp IIb/IIIa inhibition is likely to offer them greater benefit. Thus, the authors excluded patients who were most likely to benefit from this intervention. It is also possible that the difference between treatments would have been greater among patients with acute myocardial infarction.

Second, in contrast to earlier studies of Gp IIb/IIIa inhibitors in . . . [Full Text of this Article]

Sanjiv Sharma, MD; William Nyitray, MD; Brijesh Bhambi, MD
Bakersfield Heart Hospital
Bakersfield, Calif

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Glycoprotein IIb/IIIa Inhibition in Percutaneous Coronary Interventions—Reply
A. Michael Lincoff and Eric J. Topol
JAMA. 2003;290(11):1451-1452.
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