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In Reply: We agree with Dr Pedrini and colleagues that the appropriate duration of anticoagulation therapy in patients with non–ST-segment elevation acute coronary syndromes has not been rigorously evaluated. While trials could be designed to investigate optimal duration, the study requirements are potentially prohibitive. A trial with random allocation of patients to 1 of 2 study drugs for various intervals of therapy such as 1 hour, 4 hours, and 12 hours would require an enormous sample size to detect differences in outcomes.

However, large data sets such as that from the SYNERGY trial¹ provide an alternative approach to investigating the optimal duration of therapy based on associations between duration of therapy and clinical efficacy and safety outcomes. Unfortunately, these types of analyses are complicated by potential confounding bias. As an example, the timing of the outcomes is important because patients with early events often have therapy discontinued, resulting in an . . . [Full Text of this Article]

Kenneth W. Mahaffey, MD
mahaf002@mc.duke.edu

James J. Ferguson, MD; Robert M. Califf, MD for the SYNERGY Trial Investigators

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