Aernoud Fiolet

168 Chapter 6 TO THE EDITOR (5) Nidorf et al. hypothesize that the protective effect of colchicine was attributable to its antiinflammatory activity. However, it should be taken into consideration that colchicine also has antiplatelet effects, which suggests that its beneficial cardiovascular properties may be due, at least in part, to an inhibitory effect on platelet activity. 1,2 The two mechanisms are not at variance with one another, since treatments targeting inflammation may also beneficially modulate platelet activation, whereas antiplatelet drugs could ameliorate the risk of thrombosis once the trigger (plaque rupture or erosion) has occurred. 3 Unfortunately, the LoDoCo2 trial does not afford the opportunity to probe directly the possibility that colchicine-mediated platelet inhibition is a clinically relevant phenomenon, since platelet activity was not tested and bleeding events were not reported. Domenico D’Amario, M.D., Ph.D., Daniele Rodolico, M.S., Mattia Galli, M.D. Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy REFERENCES 1. Reddel CJ, Pennings GJ, Curnow JL, Chen VM, Kritharides L. Procoagulant effects of low-level platelet activation and its inhibition by colchicine. Thromb Haemost 2018;118:723-733. 2. Cimmino G, Tarallo R, Conte S, et al. Colchicine reduces platelet aggregation by modulating cytoskeleton rearrangement via inhibition of cofilin and LIM domain kinase 1. Vascul Pharmacol 2018;111:62-70. 3. Libby P, Pasterkamp G, Crea F, Jang I-K. Reassessing the mechanisms of acute coronary syndromes. Circ Res 2019;124:150-160.