CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Richard C. Becker, MD*
* Duke Clinical Research Institute, Cardiovascular Medicine, 2400 Pratt Street, Terrace Level, Room 0311, Durham, North Carolina 27705 (Email: becke021{at}mc.duke.edu).
We very much appreciate the comments of Drs. Silverstein and Guy and, as clinicians who are also asked regularly to make difficult decisions on behalf of our patients, readily acknowledge the importance of clinical trials to establish a platform for evidence-based practice. The White Paper devoted to the management of platelet-directed pharmacotherapy in patients with atherosclerotic coronary artery disease undergoing elective gastrointestinal procedures (1), although not a guideline document, was intended to provide general guidance. Indeed, "bridging therapy" is an important topic and an area in great need of randomized data, whether for patients receiving anticoagulant therapy or those with coronary arterial stents in whom platelet-directed therapy represents the standard of care to minimize life-threatening events, including stent thrombosis. The rapidly evolving landscape of intravenous platelet antagonists and oral agents with favorable "onset and offset" pharmacodynamic properties, coupled with strong encouragement from the clinical community, will undoubtedly provide an opportunity to undertake in-depth investigation (1).
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1. Becker RC, Scheinman J, Dauerman HL, et al. Management of platelet-directed pharmacotherapy in patients with atherosclerotic coronary artery disease undergoing elective endoscopic gastrointestinal procedures J Am Coll Cardiol 2009;54:2261-2275.[Abstract/Free Full Text]
Related Article
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Research Recommendations During the Writing of White Papers
- H. Robert Silverstein and J.T. Guy
J. Am. Coll. Cardiol. 2010 55: 1884.
[Full Text]
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