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Statins do not adversely affect post-interventional residual platelet aggregation and outcomes in patients undergoing coronary stenting treated by dual antiplatelet therapy.
- Source :
-
European heart journal [Eur Heart J] 2008 Jul; Vol. 29 (13), pp. 1635-43. Date of Electronic Publication: 2008 May 24. - Publication Year :
- 2008
-
Abstract
- Aims: There are growing data suggesting a clinical relevance of residual platelet aggregation (RPA) in patients undergoing PCI. Drug-drug interaction of statins and clopidogrel has been controversially discussed in ex vivo studies and clinical trials. The aim of the present study was to investigate the effects of peri-procedural statin medication on the metabolization of aspirin and clopidogrel with regard to platelet aggregation and clinical outcome in patients undergoing coronary intervention.<br />Methods and Results: Patients with coronary stenting for symptomatic coronary artery disease are routinely evaluated by platelet function analysis in a monocentre registry, and for the present study, a consecutive cohort of 1155 patients were analysed. About 87.7% of the patients were treated with statins at the time of platelet function analysis. Residual platelet activity assessed by adenosine diphosphate (20 micromol/L)-induced platelet aggregation was not significantly influenced by statin treatment. Nor the significant effects of CYP3A4-metabolization pathway on post-treatment aggregation were recorded, although there was even a trend to lower RPA values in patients treated with CYP3A4-metabolized statins. Further, in an inter-individual analysis comparing patients treated with CYP3A4- and non-CYP3A4-metabolized statins, no time-dependent difference of clopidogreĺs anti-aggregatory effects was observed. Clinical follow-up of major adverse events (myocardial infarction, ischaemic stroke, death) in 991 patients within 3 months revealed no significant adverse effects of statin treatment on clinical outcome. Instead, statin treatment was independently associated with lower incidence of composite events (HR 0.44, 95% confidence interval 0.23-0.83, P = 0.01).<br />Conclusion: Peri-procedural co-administration of statins does not increase the post-interventional RPA in cardiovascular patients treated with dual antiplatelet therapy and does not worsen the clinical prognosis of these patients.
- Subjects :
- Adult
Aged
Aged, 80 and over
Aspirin pharmacology
Clopidogrel
Cytochrome P-450 CYP3A metabolism
Drug Interactions
Drug Therapy, Combination
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors pharmacology
Male
Middle Aged
Platelet Aggregation Inhibitors pharmacology
Prognosis
Stents
Ticlopidine administration & dosage
Ticlopidine pharmacology
Aspirin administration & dosage
Coronary Stenosis therapy
Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage
Platelet Aggregation drug effects
Platelet Aggregation Inhibitors administration & dosage
Ticlopidine analogs & derivatives
Subjects
Details
- Language :
- English
- ISSN :
- 1522-9645
- Volume :
- 29
- Issue :
- 13
- Database :
- MEDLINE
- Journal :
- European heart journal
- Publication Type :
- Academic Journal
- Accession number :
- 18503057
- Full Text :
- https://doi.org/10.1093/eurheartj/ehn212