Document Detail

Inhibitory interaction between calcium channel blocker and clopidogrel. -Efficacy of cilostazol to overcome it-.
MedLine Citation:
PMID:  21857144     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The clinical effect of, and additive measures to overcome the possible inhibitory calcium channel blocker (CCB)-clopidogrel interaction in Asian patients undergoing percutaneous coronary intervention is unknown.
METHODS AND RESULTS: A total of 900 Korean patients enrolled for the multicenter, prospective, randomized Influence of CILostazol-based triple antiplatelet therapy ON ischemic complication after drug-eluting stenT implantation (CILON-T) trial were divided into 4 groups depending on CCB prescription and type of anti-platelet therapy (dual [DAT] vs. triple [TAT; addition of cilostazol to DAT]) in a 2 × 2 factorial manner. The primary endpoint was a composite of cardiac death, non-fatal myocardial infarction and ischemic stroke at 6 months after PCI. On-treatment platelet reactivity (OPR) was assessed on VerifyNow P2Y12 assay. Concomitant CCB use increased OPR in the DAT group (mean ± SEM: 251.2 ± 7.6 vs. 225.6 ± 5.1; P=0.008), but not in the TAT group (214.5±9.1 vs. 203.4 ± 5.6; P=0.294). Primary endpoint increased by use of CCB in patients with DAT (4.9% vs. 0.9%, P=0.016), but not in those with TAT (0% vs. 1.8%, P=0.346). Addition of cilostazol to DAT reduced OPR and clinical events in patients taking CCB (P=0.007 for P2Y12 reaction units; P=0.027 for thrombotic events). CCB without concomitant cilostazol use was a significant predictor of total thrombotic events.
CONCLUSIONS: Concomitant use of CCB may weaken the anti-platelet effect of clopidogrel and increase subsequent thrombotic events in Asian subjects. This hazardous CCB-clopidogrel interaction may be overcome by addition of cilostazol.
Seung-Pyo Lee; Jang-Whan Bae; Kyung Woo Park; Seung-Woon Rha; Jang-Ho Bae; Jung-Won Suh; In-Ho Chae; Myeong-Chan Cho; Hyo-Soo Kim
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2011-08-20
Journal Detail:
Title:  Circulation journal : official journal of the Japanese Circulation Society     Volume:  75     ISSN:  1347-4820     ISO Abbreviation:  Circ. J.     Publication Date:  2011  
Date Detail:
Created Date:  2011-10-26     Completed Date:  2012-02-14     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  101137683     Medline TA:  Circ J     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  2581-9     Citation Subset:  IM    
Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital.
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MeSH Terms
Brain Ischemia / etiology,  mortality
Calcium Channel Blockers* / administration & dosage,  adverse effects
Drug Antagonism*
Drug-Eluting Stents / adverse effects
Middle Aged
Myocardial Infarction / etiology,  mortality
Platelet Aggregation Inhibitors* / administration & dosage,  adverse effects
Prospective Studies
Stroke / etiology,  mortality
Tetrazoles / administration & dosage*,  adverse effects
Ticlopidine / administration & dosage,  adverse effects,  analogs & derivatives*,  antagonists & inhibitors
Reg. No./Substance:
0/Calcium Channel Blockers; 0/Platelet Aggregation Inhibitors; 0/Tetrazoles; 55142-85-3/Ticlopidine; A74586SNO7/clopidogrel; N7Z035406B/cilostazol
Comment In:
Circ J. 2011;75(11):2534-6   [PMID:  21970840 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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