Clinical InvestigationInterventional CardiologyLack of impact of calcium-channel blockers on the pharmacodynamic effect and the clinical efficacy of clopidogrel after drug-eluting stenting
Section snippets
Patient population
We prospectively evaluated the effect of platelet reactivity after clopidogrel treatment on the risk of ST in 1,608 consecutive patients undergoing PCI—predominantly with drug-eluting stent (DES) implantation—after pretreatment with 600 mg clopidogrel at the Deutsches Herzzentrum and first Medizinische Klinik, Klinikum rechts der Isar, both in Munich.8 Patients were included irrespective of their clinical presentation unless they had a contraindication to aspirin or clopidogrel or had been
Results
In our population consisting of 1,608 patients, 232 patients (14.4%) were on CCBs on admission. Baseline clinical characteristics of the study population are shown in Table I. Patients with CCBs were significantly older, more likely to be women, and had more often arterial hypertension, more diabetes, and a higher body mass index compared to patients without CCB treatment. Among CCB-treated patients, the prescribed CCB was amlodipine in 171 patients (73.7%), lercanidipine in 23 patients (9.9%),
Discussion
The main finding of this study is that in our population, concomitant CCB therapy does not alter clopidogrel-mediated platelet aggregation measured by MEA and that there was no statistical difference in the incidence of death or ST and other ischemic events.
To the best of our knowledge, this is the largest patient population that was evaluated in this context. In this study, most patients received amlodipine, which showed no attenuation of platelet aggregation. Patients treated with verapamil,
Conclusion
In this large retrospective post hoc analysis, we found no evidence that concomitant CCB therapy does alter clopidogrel-mediated platelet aggregation and that there was no measurable impact on the incidence of ST, mortality, and other ischemic events. Further studies are needed to evaluate the pharmacodynamic and clinical impact of concomitant CCB treatment in patients with clopidogrel therapy after coronary stenting.
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2015, European Journal of PharmacologyCitation Excerpt :Therefore, the study suggests that drug–drug interactions between clopidogrel and the non P-glycoprotein inhibiting amlodipine might be more clinically relevant as compared to P-glycoprotein inhibiting dihydropyridines (Harmsze et al., 2010). Other observational studies have found that co-administration of calcium antagonists is associated with a diminished clopidogrel-induced response (Gremmel et al., 2010), which, however, was not confirmed in other investigations (Sarafoff et al., 2011; Good et al., 2012; Li et al., 2013). The concerns surrounding drug–drug interaction between amlodipine and clopidogrel indeed raise the question on alternative strategies for ischemic relief in patients with chronic stable angina (Montalescot et al., 2013).
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2013, JACC: Cardiovascular InterventionsCitation Excerpt :In a Danish registry of patients after MI, patients on a CCB were observed to have an increased risk of CV events regardless of whether or not they were treated with clopidogrel, thereby suggesting the increase in risk was likely explained by unidentified confounders (22). More recently, there was no evidence of an interaction between clopidogrel and CCB use in a post hoc analysis of 2,116 subjects in a randomized trial of 2 dosage regimens of clopidogrel post-PCI (23) or in 1,608 subjects after placement of a drug-eluting stent (21). In the current analysis of 13,608 subjects with ACS, we did not find that CYP3A4-metabolized statins, CCBs, or concomitant use of both medications attenuated the clinical efficacy of clopidogrel.
The influencing factors for clopidogrel-mediated platelet inhibition are assay-dependent
2011, Thrombosis ResearchCitation Excerpt :By the VASP assay and the Impact-R, a significant influence of concomitant CCB medication was only seen by univariate, but not by multivariate analysis. Like in a recent study by Sarafoff et al., we did not observe an attenuation of clopidogrel-mediated platelet inhibition by CCB in MEA [44]. Thus, CCB seem to have some influence on ADP-mediated platelet activation, but the effect may be outweighed if other factors are also taken in consideration.
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