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In reply

We appreciate the interest and the comments by Ziegelstein regarding our article.¹ Ziegelstein pointed out that the lack of long-term clopidogrel use among patients with NSTE ACS may be related to the fact that the guideline recommendation regarding use of clopidogrel after discharge is currently based on the results of only 1 clinical trial, the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial.² Moreover, Ziegelstein found the results of the CURE trial itself not convincing, because the benefit of clopidogrel was partially counterbalanced by an increased bleeding risk.

While we cannot say whether the low use of clopidogrel has occurred only after thoughtful and critical review of the evidence by community physicians, we believe that other factors may be at play. The use of several less controversial and expensive therapies such as -blockers, statins, and angiotensin-converting enzyme inhibitors have lagged decades after the publication of evidence . . . [Full Text of this Article]

AUTHOR INFORMATION
Pierluigi Tricoci, MD, MHS, PhD; Matthew T. Roe, MD, MHS; Eric D. Peterson, MD, MPH

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