Underuse of antiplatelets and inappropriate use

We have read the findings by Monesi et al. in the Journal on the appropriateness of antiplatelet therapies in a large cross-sectional study in Italy [1]. Not surprisingly, they found low use of antiplatelets for primary and secondary prevention. We have a few comments and questions regarding their paper. The authors do not mention specifically how the drug treatments were collected. Were patients questioned by their doctors at the time of study, or were the data obtained from pharmacies? We are also curious as to why patients with atrial fibrillation were excluded from this study. Although we agree that most patients should be considered for antithrombotic therapy (i.e., warfarin), there are sufficient data to support the use of aspirin in individuals with atrial fibrillation who are at fairly low absolute risk of stroke or who have contraindications to warfarin [2]. Furthermore, the authors did not show which other medications the patients were receiving that may have made low-dose aspirin inappropriate (for instance, warfarin for deep vein thrombosis prophylaxis, current nonsteroidal antiinflammatory or prednisolone use, and so on).