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To the Editor: In the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) Timing trial, Dr Stone and colleagues¹ reported that more than 10% of patients developed thrombocytopenia, defined as a platelet count of less than 150 000/µL. Prior studies have defined thrombocytopenia as either less than 100 000/µL or at least a 25% decrease from baseline, with incidence ranging from 0.5% to 5.6%.^2-3 It is unclear how many patients in the ACUITY trial developed significant thrombocytopenia using these alternative definitions.

In the Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events (REPLACE) 2 trial,⁴ the investigators showed a statistically significant decrease in incidence of moderate (<100 000/µL) and severe (<50 000/µL) thrombocytopenia with bivalirudin, a direct thrombin inhibitor, compared with combined unfractionated heparin and glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors during percutaneous coronary intervention. Patients who develop thrombocytopenia with the use of GP IIb/IIIa inhibitors have increased risk of bleeding complications and ischemic . . . [Full Text of this Article]

Harris V. K. Naina, MBBS
naina.harris@mayo.edu

Samar Harris, MBBS; Atul Singla, MBBS
Department of Internal Medicine
Mayo Clinic College of Medicine
Rochester, Minnesota

RELATED LETTER

Timing of Glycoprotein IIb/IIIa Inhibitors in Acute Coronary Syndromes—Reply
Gregg W. Stone and for the ACUITY Investigators
JAMA. 2007;298(1):37-38.
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RELATED ARTICLE

Routine Upstream Initiation vs Deferred Selective Use of Glycoprotein IIb/IIIa Inhibitors in Acute Coronary Syndromes: The ACUITY Timing Trial
Gregg W. Stone, Michel E. Bertrand, Jeffrey W. Moses, E. Magnus Ohman, A. Michael Lincoff, James H. Ware, Stuart J. Pocock, Brent T. McLaurin, David A. Cox, M. Zubair Jafar, Harish Chandna, Franz Hartmann, Franz Leisch, Ruth H. Strasser, Martin Desaga, Thomas D. Stuckey, Richard B. Zelman, Ira H. Lieber, David J. Cohen, Roxana Mehran, Harvey D. White, and for the ACUITY Investigators
JAMA. 2007;297(6):591-602.
ABSTRACT | FULL TEXT  

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