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May 8, 1992

Eric Roehm, M.D.
2300 Round Rock Ave.
Round Rock , TX    78681

Dear Dr. Roehm,

Thank you for your letter which caught up with me on sabbatical in Italy.   I agree with many of your points on aspirin absorption. Incidentally the first paper I ever published was a small randomized crossover trial of the absorption of different aspirin tablets. (LANCET? 1960). The Fitzgerald 80 mg (inadequate) is now published – see references 7, 8, 42 in ISIS-III paper. The safety of 325 mg of aspirin with tPA was tested in the ECS trial.  GUSTO will test again, but not of course versus placebo, so if there are excess bleeds, we won’t know if it is tPA or aspirin or both.

I hope TIMI IIIB will advise chewed aspirin as you suggest.

You may be right about angioplasty.  In the Circulation editorial I wrote about TIMI IIA, I pointed out that although not significant, there was a 25% benefit for angioplasty – similar to the streptokinase result in ISIS-II but less power in TIMI.

Yours sincerely,

Peter Sleight  (D.M., Professor of Cardiology)     original letter