Letters and Comments

AUTHORS REPLY: Thank you for bringing this error to our attention.

REFERENCES

1. Mallal S, Phillips E, Carosi G, et al. HLA-B*5701 screening for hypersensitivity to abacavir. N Engl J Med 2008;358:568-79.
2. Vandekerckhove L, Blot S, Vogelaers D. Abacavir hypersensitivity (letter). N Engl J Med 2008;358:2514-5.
3. Shear NH, Milpied B, Bruynzeel DP, Phillips EJ. A review of drug patch
testing and implications for HIV clinicians. AIDS 2008;22:999-1007.
4. Waters LJ, Mandalia S, Gazzard B, Nelson M. Prospective HLA-B*5701
screening and abacavir hypersensitivity: a single centre experience.
AIDS 2007;21:2533- 4.

Comment: Aspirin, Clopidogrel, and Warfarin: Is the Combination

Appropriate and Effective or Inappropriate and Too Dangerous?
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 articles
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.

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@exchange.hsc.mb.ca

Upon review of the wording in the inclusion criteria, we agree with your
assessment that antiplatelet therapy was intended to be single therapy
with either aspirin or a thienopyridine. Therefore, the study by Anand et
al. (reference 35), first described on page 800, and the data in Table 2, on
page 797, should not have been included in our review. However, exclusion of this information does not change our conclusion. We apologize
for the error.
A Janelle Hermosillo PharmD

Clinical Pharmacist
Cardiothoracic Surgery
St. Lukes Hospital
Bethlehem, Pennsylvania
Sarah A Spinler PharmD FCCP BCPS (AQ Cardiology)

Professor of Clinical Pharmacy

Philadelphia College of Pharmacy
University of the Sciences in Philadelphia
600 South 43rd Street
Philadelphia, Pennsylvania 19103
fax 215/596-8586
s.spinle@usip.edu
Published Online, 2 Sept 2008, www.theannals.com
DOI 10.1345/aph.1K591b

Correction: Aspirin, Clopidogrel, and Warfarin: Is the Combination

Appropriate and Effective or Inappropriate and Too Dangerous?
In this article (2008;42:790-805), on page 793, column 2, the penultimate sentence should appear without the phrase of the aforementioned
studies. It should read: A recent meta-analysis found a higher incidence
of major bleeding in patients receiving aspirin and warfarin compared
with the incidence in patients receiving warfarin alone (OR 1.43 [95%
CI 1.00 to 2.02]).23 Second, reference 25, cited on page 794, column 1,
should be replaced with: Leon MB, Baim DS, Popma JJ, et al. A clinical
trial comparing three antithrombotic-drug regimens after coronary-artery
stenting. Stent Anticoagulation Restenosis Study Investigators. N Engl J
Med 1998;339:1665-71. Third, on page 794, column 1, the sentence citing reference 26 should cite reference 13 instead.
Published Online, 2 Sept 2008, www.theannals.com
DOI 10.1345/aph.1K591c

Published Online, 2 Sept 2008, www.theannals.com

DOI 10.1345/aph.1K591a
REFERENCES

1. 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
2. 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.

www.theannals.com

Letters are subject to review prior to acceptance. They should address areas related to
pharmacy practice, research, or education, or articles recently published. Corrections
of previously published material also are accepted. Letters are limited to no more
than five authors. In cases where adverse effects or drug interactions are described,
the Naranjo ADR probability scale (Clin Pharmacol Ther 1981;30:239- 45) or DIPS
scale (Ann Pharmacother 2007;41:674-80. DOI 10.1345/aph.1H423), respectively,
should be used to determine the likelihood that the adverse effect or interaction was
drug-related. Text: limit 500 words. References: limit 5. Art: limit 1 table or figure.

The Annals of Pharmacotherapy

Downloaded from aop.sagepub.com at Freie Universitaet Berlin on May 5, 2015

2008 October, Volume 42

1521