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Density determination of bupivacaine and bupivacaine-opioid mixtures for spinal anesthesia.

We appreciate Dr. Fattorutto’s interest in our case report and his passion in his opinions. Unfortunately, however, we fail to understand on what basis he draws the conclusion that the PFA-100 is insensitive to platelet dysfunction induced by clopidogrel. Indeed, the studies cited by Dr. Fattorutto support the use of the PFA-100 for this very purpose. In the Fischetti study (1) the authors do not address the clinical applicability of the PFA-100 as a tool, but rather use it to investigate the phenomenon of platelet aggregation following coronary angioplasty. Fischetti, et al. demonstrate that ticlopidine’s effects on platelet aggregability are detected by the PFA-100. Similarly, the KottkeMarchant study (2) also examines platelet function in the setting of coronary angioplasty. Although this study is a closer evaluation of the PFA-100 itself, it does not examine the role of ticlopidine as a sole agent to decrease platelet aggregability. To view this study as an indictment of the PFA-100 in this regard is less than objective. The PFA-100 has not been specifically studied as a tool to assess clopidogrel-induced platelet dysfunction in an ambulatory setting. The vast preponderance of investigation, however, supports the use of the technology as a sensitive and specific tool for the detection of drug-induced platelet dysfunction, including that caused by the thienopyridines (3).