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  Vol. 296 No. 1, July 5, 2006 TABLE OF CONTENTS
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Medical Management of Peripheral Arterial Disease

Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: In their Clinical Review, Dr Hankey and colleagues1 discussed medical management for peripheral arterial disease (PAD), which they document as a strong risk factor for cardiovascular morbidity and mortality. While I agree with their advice that all patients with this condition warrant treatment with an antiplatelet drug, I disagree with their statement that aspirin is "the preferred antiplatelet drug because it is effective and inexpensive."

Two active comparator randomized trials showed that alternative antiplatelet agents—clopidogrel2 and picotamide3—were superior to aspirin for the prevention of cardiovascular events in patients with PAD. In patients with both PAD and type 2 diabetes mellitus, picotamide reduced the risk of death by 45% in comparison with aspirin (relative risk [RR], 0.55; 95% confidence interval [CI], 0.31-0.98).3 Moreover, in the Clopidogrel vs Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial, clopidogrel reduced the cardiovascular event rate by 24% in comparison . . . [Full Text of this Article]

Daniel G. Hackam, MD, FRCPC
daniel.hackam@ices.on.ca
Division of Clinical Pharmacology & Toxicology
University of Toronto
Toronto, Ontario



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