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Abstract

Reply: According to Winning et al., continuous administration of antiplatelet drugs to patients at risk for organ dysfunction resulted in significantly lower mortality and a shorter hospital stay. These results support the notion that antiplatelet drugs are useful for patients at risk for organ dysfunction. In our study, pretreatment with clopidogrel (CS) reduced LPS-induced liver and lung injury as reflected by a reduction in serum cytokine (TNF-α, IL-6, and HMGB1) levels and HMGB1 expression in liver and lung tissues in a rat model (1). Clopidogrel was administered 5 days before LPS injection. In a preliminary experiment, however, no improvements in organ injury were observed when CS was administered 1 or 3 days before LPS injection. These results suggest the possibility that antiplatelet drugs do not work posttreatment. Accordingly, if anticoagulant therapy was needed, using the antiplatelet drug was related to reducing the organ dysfunction. Previous studies have shown that antiplatelet drugs have beneficial effects against systemic inflammation (2, 3). These studies suggested that antiplatelet drugs modulate the inflammatory response by inhibiting the release of platelet-derived mediators that directly cause tissue damage. Moreover, antiplatelets drugs ameliorated the involvement of platelets linking the innate and adaptive immune responses at inflammation response. Thus, antiplatelet drugs may be effective against not only acute systemic inflammation, but also chronic inflammatory diseases (2, 3). We speculated that antiplatelet drugs would improve the survival of patients requiring anticoagulant therapy due to systemic inflammation. However, it was unknown whether long-term treatment with antiplatelet drugs would be useful for patients at risk of organ dysfunction. Randomized controlled studies on the organ-protective effects of antiplatelet drugs would be necessary to address this question, and if such studies were performed, they would contribute to the notion that antiplatelet drugs are effective in this patient population. Satoshi Hagiwara Hideo Iwasaka Takayuki Noguchi Department of Anesthesiology and Intensive Care Medicine Oita University Faculty of Medicine Yufu, Oita, Japan