Would a large dose of vitamin E (1,600-2,400 IU) be an appropriate choice as a platelet inhibitor in a CAD patient who is allergic to aspirin, intolerant of clopidogrel (Plavix), and reluctant to take ticlopidine (Ticlid)? He has read about its impressive risk factors and he has multiple drug intolerances. If not large doses of vitamin E, what would you suggest?
—BENJAMIN WOFFORD, MD, Conover, N.C.

I think you have to better define “intolerance” to Plavix. This is our No. 1 substitute and/or additive to aspirin usage in patients with CAD. I would certainly review this issue with the patient because, short of a severe reaction, this would be the best choice. Ticlid’s side effects make it far less helpful. There is no advantage to superdoses of vitamin E larger than the standard 400-800 IU doses. The larger doses used to achieve potent antioxidant effects have been reported to increase all-cause mortality (Ann Intern Med. 2005;142:37-46), so clinician, beware.
— Peter F. Cohn, MD (119-2)