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To the Editor: The study on excess dosing of antithrombotic therapies in patients with non–ST-segment elevation acute coronary syndromes by Dr Alexander and colleagues¹ did not examine the use of other antithrombotic treatments, such as aspirin or clopidogrel, whereas these drugs are recommended in the treatment of these syndromes.^2-3 Increased bleeding risk could have been associated with the combined use of these antithrombotic medications, and such potential confounding should be considered.

Furthermore, patients with high risk of bleeding are also patients with high risk of acute coronary syndrome complications.⁴ Difficulties in the treatment of high-risk patients have been discussed in the CRUSADE Quality Improvement Initiative.⁵ Therefore, the evaluation of the bleeding risk, as well as the attributable risk of excess dosing, remain major challenges. The optimal dose of aspirin, clopidogrel, heparin, or glycoprotein IIb/IIIa inhibitors based on the bleeding risk when used alone may be very different from that based . . . [Full Text of this Article]

Frédéric Lapostolle, MD
frederic.lapostolle@avc.ap-hop-paris.fr

Jean Catineau, MD; Claude Lapandry, MD; Frédéric Adnet, MD
Service d’Aide Médicale Urgente
Centre Hospitalier Universitaire
Hôpital Avicenne
Bobigny, France

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