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J Thorac Cardiovasc Surg 2005;129:1197-1198
© 2005 The American Association for Thoracic Surgery

Letters to the Editor

Reply to the Editor

Eric Lim, MRCS

Papworth Hospital, Cambridge, United Kingdom

In our reply to Raja, we have addressed a similar query with regard to the dosing regimen of clopidogrel. It is vitally important to appreciate that the study in which Hunt and associates quote the time to the onset of the effects of clopidogrel (4 to 7 days) is from a sample of healthy subjects.1 Nonrandomized studies after coronary artery bypass surgery suggest that it takes 9 to 28 days.2 Our results are consistent with the latter.

In our article, you will note that we reported all measurements as the percentage change compared with baseline.3 The baseline sample was taken on the day before surgery.

We respectfully disagree with the final comment of Hunt. A previous observational study and our randomized data are consistent regarding the inefficacy of clopidogrel early after coronary surgery assessed on aggregometry. At present, we are unaware of any evidence to the contrary; therefore, the onus should be to prove that an effect exists before prescribing clopidogrel (as the sole antiplatelet in this time frame), rather than subjecting patients to the possibility of ineffective treatment while awaiting a "greater understanding of the likely mechanisms of clopidogrel responsiveness."

References

  1. Savcic M, Hauert J, Bachmann F, Wyld PJ, Geudelin B, Cariou R. Clopidogrel loading dose regimens. kinetic profile of pharmacodynamic response in healthy subjects. Semin Thromb Hemost 1999;25(suppl 2):15-19.
  2. David JL, Limet R. Antiplatelet activity of clopidogrel in coronary artery bypass graft surgery patients. Thromb Haemost 1999;82:1417-1421.[Medline]
  3. Lim E, Cornelissen J, Routledge T, Kirtland S, Charman SC, Bellm S, et al. Clopidogrel did not inhibit platelet function early after coronary bypass surgery. a prospective randomized trial. J Thorac Cardiovasc Surg 2004;128:432-435.[Abstract/Free Full Text]




This Article
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Right arrow Articles by Lim, E.
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Right arrow Cardiac - pharmacology
Right arrow Cardiac - physiology
Right arrow Coronary disease

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