Effect of Atorvastatin and Pravastatin on Platelet Inhibition by Aspirin and Clopidogrel Treatment in Patients With Coronary Stent Thrombosis

• Published in: The American journal of cardiology 2007-02, Vol.99 (3), p.353-356
• Main Authors: Wenaweser, Peter, MD, Windecker, Stephan, MD, Billinger, Michael, MD, Cook, Stephane, MD, Togni, Mario, MD, Meier, Bernhard, MD, Haeberli, Andre, MD, Hess, Otto M., MD
• Format: Article
• Language: English
• Subjects: Aged; Aspirin - adverse effects; Atorvastatin Calcium; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Coronary heart disease; Coronary Restenosis - blood; Coronary Restenosis - chemically induced; Coronary Restenosis - drug therapy; Drug Interactions; Drug therapy; Drug Therapy, Combination; Drugs; Electrocardiography; Female; Heart; Heptanoic Acids - therapeutic use; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Male; Medical sciences; Middle Aged; Platelet Aggregation - drug effects; Platelet Aggregation Inhibitors - adverse effects; Pravastatin - therapeutic use; Prospective Studies; Prosthesis Failure; Pyrroles - therapeutic use; Side effects; Stents; Ticlopidine - adverse effects; Ticlopidine - analogs & derivatives; Treatment Outcome
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2006.08.036

We sought to determine a potential interaction between statins and antiplatelet therapy with aspirin and clopidogrel. Previous laboratory studies have shown a possible drug-drug interaction of statins metabolized by cytochrome P450 3A4 and clopidogrel (prodrug metabolized by cytochrome P450 3A4), resulting in an impaired inhibitory effect of clopidogrel on platelet aggregation. However, conclusive prospective data assessing this potentially relevant interaction are lacking. In 73 patients, 23 with previous coronary stent thrombosis (ST) (ST group) and 50 without coronary ST (control group), platelet aggregation was measured 3 times in monthly intervals using light transmission aggregometry (adenosine diphosphate [ADP] and arachidonic acid induction). Measurements were carried out with aspirin monotherapy (100 mg/day), dual antiplatelet therapy with aspirin plus clopidogrel (75 mg/day), and additional treatment of 20 mg/day of atorvastatin or 40 mg/day of pravastatin. ADP (5 and 20 μmol)-induced platelet aggregation was significantly decreased with clopidogrel (p