Inhibitory Interaction Between Calcium Channel Blocker and Clopidogrel - Efficacy of Cilostazol to Overcome It
- Authors
- Lee, Seung-Pyo; Bae, Jang-Whan; Park, Kyung Woo; Rha, Seung-Woon; Bae, Jang-Ho; Suh, Jung-Won; Chae, In-Ho; Cho, Myeong-Chan; Kim, Hyo-Soo
- Issue Date
- Nov-2011
- Publisher
- JAPANESE CIRCULATION SOC
- Keywords
- Calcium channel blocker; Cilostazol; Clopidogrel; Platelet function test; Thrombosis
- Citation
- CIRCULATION JOURNAL, v.75, no.11, pp.2581 - 2589
- Indexed
- SCIE
SCOPUS
- Journal Title
- CIRCULATION JOURNAL
- Volume
- 75
- Number
- 11
- Start Page
- 2581
- End Page
- 2589
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/111281
- DOI
- 10.1253/circj.CJ-11-0113
- ISSN
- 1346-9843
- Abstract
- 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 2x2 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. (Circ J 2011; 75: 2581-2589)
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