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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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