Oral anticoagulation with coumarin derivatives and antiplatelet effects of clopidogrel
| Autor: | Albert Schömig, Adnan Kastrati, Nicolas von Beckerath, Nikolaus Sarafoff, Dirk Sibbing, Julia Stegherr, Siegmund Braun, Tanja Morath, Stefanie Schulz, Julinda Mehilli |
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| Rok vydání: | 2010 |
| Předmět: |
Male
medicine.medical_specialty Ticlopidine Platelet Aggregation medicine.medical_treatment Administration Oral Coronary Artery Disease Phenprocoumon Internal medicine Medicine Humans Platelet Drug Interactions cardiovascular diseases Angioplasty Balloon Coronary Aged Aged 80 and over Aspirin business.industry Percutaneous coronary intervention Anticoagulants Middle Aged Clopidogrel Adenosine Diphosphate Cross-Sectional Studies Anesthesia Conventional PCI Multivariate Analysis Cardiology Platelet aggregation inhibitor Drug Therapy Combination Female Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors circulatory and respiratory physiology medicine.drug |
| Zdroj: | European heart journal. 31(10) |
| ISSN: | 1522-9645 |
| Popis: | Aims A relevant proportion of patients receiving aspirin and clopidogrel after percutaneous coronary intervention (PCI) also require oral anticoagulation with a coumarin derivative such as phenprocoumon. Both clopidogrel and phenprocoumon are metabolized by the hepatic cytochrome P450 system and a drug–drug interaction may exist at this level. The aim of this study was to investigate the impact of phenprocoumon on the antiplatelet effects of clopidogrel in patients with coronary artery disease. Methods and results Patients ( n = 1223) eligible for this study were under dual maintenance antiplatelet treatment with aspirin and clopidogrel. Adenosine diphosphate-induced platelet aggregation (in AU*min) was measured with multiple electrode platelet aggregometry on a Multiplate analyzer (Dynabyte, Munich, Germany). From the entire study population, 124 (10.1%) patients were under concomitant phenprocoumon treatment at the time point of platelet function testing. Platelet aggregation (median [interquartile range]) was significantly higher in patients with ( n = 124) concomitant phenprocoumon treatment compared with patients without ( n = 1099) phenprocoumon treatment (308 [190–493] AU*min vs. 224 [145–390] AU*min; P = 0.0001, adjusted P = 0.002). Conclusion Phenprocoumon significantly attenuates the antiplatelet effects of clopidogrel. The impact of this interaction on the risk of thrombotic and bleeding events after PCI requires further investigations. |
| Databáze: | OpenAIRE |
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