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Specific guide to this web site for:
1. Medical
School
Educators
in
Statistics
2. Medical Students
3. Science media writers
4. High School & College
Statistic Teachers
Misadventures:
1. Harvard led MI study
2. JACC
study
(J. of Amer. Coll.
Cardio.)
3. NEJM
cath study
4. Amer. J. of Cardio.
review of literature
5. ALLHAT
controversy
6. Oat bran study
7. Pregnancy & Alcohol
8. Are Geminis
really
different?
9. Columbia 'Miracle' Study
Additional
Topics:
Celebrex
Limitations of Meta-Analyses
Large Randomized Clinical
Trials
Tale of Two Large
Trials
Advocate
meta-analyses
Network
meta-analyses
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Eric Roehm, M.D.
December 29, 1994
Robert Roberts, M.D.
Chief of Cardiology
Baylor College of Medicine
6535 Fannin, Mail Station F-905
Houston, TX 77030
Dear Dr. Roberts,
Your group recently published a study on the effect of low dose aspirin on the inhibition of platelet aggregation during the first two hours following acute aspirin ingestion. Your study documents that low dose aspirin inhibits arachidonic acid precipitated platelet aggregation completely and early following aspirin ingestion.
The question remains whether this inhibition of arachidonic acid precipitated platelet aggregation with low dose aspirin is representative of the results obtainable when other agents are used to induce platelet aggregation. My understanding of the position taken by you in a recent talk given in Austin is that the literature suggests this finding holds true regardless of which platelet aggregation agent is employed. The study by Kuster et al is thought to be an outlier from the other experimental data published, possibly on the basis of problems with his platelet aggregometer technique.
I submit this challenge and alternative hypothesis. Review the accompanying materials for the next five minutes. In my opinion, this will show that the prior experimental literature, including your study and the Kuster et al study (among
others), is consistent with one another in
general.
Low dose, acute ingestion of aspirin with arachidonic acid precipitated platelet aggregation fully inhibits platelet aggregation. Collagen precipitated aggregation is not inhibited by single doses of low dose aspirin.
Unfortunately, the literature in your review inadvertently misquoted the prior literature. This results in the erroneous impression that the literature in general indicates that the inhibition of platelet aggregation is independent of which aggregatory agent is employed except for the Kuster study, which is an outlier. A closer review of the data from these studies shows that the data generated by the Kuster study, Mehta study, Paccioretti study, and your study is consistent and that the data from no study is appropriately discarded.
Enclosed is the information for your direct review.
link to printed literature that accompanied Robert Robert's letter
Sincerely yours,
Eric F. Roehm, M.D.
Encls.
cc: Salim Dabaghi, M.D. Andrew Schafer, M.D. Neal Kleiman, M.D.
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