Antiplatelet therapy and atherosclerotic events

doi:10.1136/bmj.324.7342.917

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Commentary is inaccurate

Cathie Sudlow, Wellcome clinician scientist. (csudlow@skull.dcn.ed.ac.uk),
Peter Sandercock, professor of medical neurology.,
Charles Warlow, professor of medical neurology.

Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU
University of North Carolina-Chapel Hill, 5039 Old Clinic Building, UNC Hospital, Chapel Hill, NC 27599-7110, USA
University of Texas Health Science Center at San Antonio, Audie Murphy VA Hospital 11c6, 7400 Merton Minter Boulevard, San Antonio, TX 78229-5700, USA

EDITOR—We endorse the response of Baigent and others to Cleland's commentary on the Antithrombotic Trialists' antiplatelet meta-analysis.1, 2, 3 We would like to add some further comments in response to Cleland's article and the editorial in the same issue.4

Both suggest that the data in the meta-analysis were revised retrospectively. But the overview methods were planned prospectively. Differences between the data in trial publications and the dataset used for the meta-analysis occurred where trialists provided additional information on the numbers of patients originally randomised, or on unpublished or subsequently available outcomes for small numbers of patients. Minor differences between the current and previous antiplatelet overviews generally relate to additional, unpublished data from a few trials and do not affect any of the results or conclusions.

The claim by Reilly and FitzGerald that the absolute reduction in vascular events with antiplatelet treatment is smaller in acute ischaemic stroke than in other high risk conditions is incorrect. For every 1000 patients treated, about 10 events are prevented in the first month after onset of stroke, and just over one event …