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In Reply: As Dr Naina and colleagues note, the REPLACE-2 randomized trial of 6010 patients undergoing percutaneous coronary intervention, comparing bivalirudin monotherapy with unfractionated heparin plus GP IIb/IIIa inhibitors, demonstrated a reduction in thrombocytopenia defined as a nadir platelet count of less than 100 000/µL (0.7% vs 1.7%, respectively; P < .001) and less than 50 000/µL (0.3% vs 0.7%, respectively; P = .03).¹ In the ACUITY trial of 13 819 patients with acute coronary syndromes, the development of thrombocytopenia to less than 100 000/µL was more frequent, possibly related to the longer duration of antithrombin and antiplatelet agent administration after emergency department initiation in this patient cohort (Table). Bivalirudin monotherapy reduced the development of moderate and severe thrombocytopenia in the ACUITY trial to a similar extent as that seen in REPLACE-2 (Table). Severe thrombocytopenia (nadir platelet count <50 000/µL) was least frequent in patients assigned to bivalirudin alone compared with a GP . . . [Full Text of this Article]

Gregg W. Stone, MD
gs2184@columbia.edu
Columbia University Medical Center
New York, New York

for the ACUITY Investigators

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Timing of Glycoprotein IIb/IIIa Inhibitors in Acute Coronary Syndromes
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Routine Upstream Initiation vs Deferred Selective Use of Glycoprotein IIb/IIIa Inhibitors in Acute Coronary Syndromes: The ACUITY Timing Trial
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