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To the Editor: We agree with the proposal of Dr Eisenstein and colleagues¹ for a 3-group clinical trial based on the duration of clopidogrel therapy to further investigate the role of dual anticoagulation with clopidogrel and aspirin following DES implantation. In addition, it might be worthwhile to further analyze patients in "ideal" and "real life" subgroups.

Clinical trials of stent use have generally selected "ideal" study patients, with clinical and angiographic exclusion criteria such as severe left ventricular systolic dysfunction, renal insufficiency, bifurcation lesions, recent acute myocardial infarction, ostial lesions, calcified vessels, and vessels containing thrombus.^2-3 Approval of DES has led to their widespread use, and significant numbers of DES are being used for off-label indications or "real life" patients.⁴ Extended dual anticoagulation with clopidogrel and aspirin has its own bleeding risks and also has financial implications. Subgroup analysis of patients may help define a high-risk group and determine optimal . . . [Full Text of this Article]

Aman Khurana, MD
akhurana@usd.edu

Namita Vinayek, MD
Sioux Valley Hospital
University of South Dakota Medical Center
Sioux Falls

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JAMA. 2007;297(16):1770-1771.
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