Published Online, 2 September 2008, www.theannals.com, DOI 10.1345/aph.1K591a.
The Annals of Pharmacotherapy: Vol. 42, No. 10, pp. 1521. DOI 10.1345/aph.1K591a
© 2008 Harvey Whitney Books Company.
Comment: Aspirin, Clopidogrel, and Warfarin: Is the Combination Appropriate and Effective or Inappropriate and Too Dangerous?
Mark Friesen, PharmD
Clinical Pharmacist Cardiology/Internal Medicine Department of
Pharmaceutical Services Health Sciences Centre MS189 820 Sherbrook Street
Winnipeg, Manitoba R3A-1R9, Canada fax 204/787-3195
MHFriesen{at}exchange.hsc.mb.ca
Published Online, September 2, 2008. www.theannals.com, DOI 10.1345/aph.1K591a
TO THE EDITOR: I am writing in reference to the article by Hermosillo and
Spinler.1 The
last paragraph on page 800 begins with the sentence, "In the only
randomized trial reported to date, of patients with peripheral arterial
disease (PAD) and either ACS [acute coronary syndrome] or intracoronary stent
placement, the WAVE trial investigators sought to determine whether triple
antithrombotic therapy was superior to dual antithrombotic therapy."
When I retrieved the reference for this
sentence,2 it
seemed that there was a misinterpretation of this trial by the article's
authors. The WAVE is not a study examining dual versus triple therapy;
instead, it is a study of antiplatelet monotherapy versus antiplatelet plus
warfarin therapy. The patient could be on aspirin or clopidogrel as
antiplatelet therapy, but not both, as Hermosillo and Spinler suggest. The
referenced study specifically states, on page 218, "Dual antiplatelet
therapy was not permitted unless the patient had an acute coronary syndrome or
a coronary stent during follow-up." There is no mention in the rest of
the paper of how many patients had ACS or a stent, so there is no way of
knowing how many patients were on triple therapy. But, clearly, triple therapy
was not what the trial was designed to examine.
References
- Hermosillo AJ, Spinler SA. Aspirin, clopidogrel, and warfarin: is
the combination appropriate and effective or inappropriate and too dangerous? Ann Pharmacother 2008;42:790-805.
Epub 13 May 2008. DOI 10.1345/aph.1K591[Abstract/Free Full Text]
- Anand S, Yusuf S, Montague P, et al. Warfarin Antiplatelet Vascular
Evaluation trial investigators (WAVE). Oral anticoagulant and antiplatelet
therapy and peripheral arterial disease. N Engl J Med 2007;357:217-26.[Abstract/Free Full Text]
