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Medical Management of Peripheral Arterial Disease—Reply
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In Reply: Dr Hackam disagrees with our conclusion that aspirin is the preferred antiplatelet drug for PAD, citing randomized studies of clopidogrel1 and picotamide2 to suggest that these agents are more effective than aspirin. The CAPRIE trial was designed to compare the effectiveness and safety of clopidogrel and aspirin in patients at high vascular risk and showed that clopidogrel is marginally but significantly more effective than aspirin in preventing myocardial infarction, stroke, or death in all patients with high vascular risk (relative risk reduction [RRR], 8.7%; 95% CI, 0.3%-16.5%; P = .04). The study was not designed or powered to provide reliable conclusions about the effectiveness and safety of clopidogrel and aspirin in patients with PAD.
A subgroup analysis of CAPRIE did show that clopidogrel was more effective than aspirin in patients with PAD (RRR, 23.8%; 95% CI, 8.9%-36.2%; P = .003) but a test of heterogeneity of the treatment effects among . . . [Full Text of this Article]
John Eikelboom, MBBS, MSc
eikelbj@mcmaster.ca
Department of Medicine
McMaster University
Hamilton, Ontario
Graeme Hankey, MD
Department of Neurology
Royal Perth Hospital and School of Medicine and Pharmacology
Perth, Australia
Paul Norman, DS
School of Surgery and Pathology
University of Western Australia
Perth
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