Inhibitory Interaction Between Calcium Channel Blocker and Clopidogrel : Efficacy of Cilostazol to Overcome It
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概要
- 論文の詳細を見る
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. (Circ J 2011; 75: 2581-2589)
- 社団法人 日本循環器学会の論文
- 2011-10-25
著者
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Lee Seung-Pyo
Cardiovascular Center, Seoul National University Hospital
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Suh Jung-Won
Cardiovascular Center, Seoul National University Bundang Hospital
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Park Kyung
Department Of Laboratory Medicine Seoul National University College Of Medicine:seoul National Unive
-
Park Kyung-woo
韓国
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Kim H‐s
Seoul National University Hospital
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Suh Jung-won
Seoul National University Bundang Hospital
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Park Keun-Ho
Seoul National University Hospital
-
Kang Hyun-jae
韓国
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Kang H‐j
Seoul National University Hospital
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Park Young-bae
韓国
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Park Y‐b
Division Of Cardiology Department Of Internal Medicine Seoul National University College Of Medicine
-
Song Jong-min
Seoul National University Bundang Hospital
-
Park Keun-ho
Department Of Laboratory Medicine Seoul National University College Of Medicine:seoul National Unive
-
Park Keun-ho
韓国
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SUH Jung-Won
Jeju self-government province
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KIM Hyo-Soo
Jeju self-government province
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Lee Sang-eun
Cardiovascular Center Seoul National University Hospital
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Park Kyung
韓国
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Park Hyo
韓国
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RHA Seung-Woon
Cardiovascular Center, Korea University Guro Hospital
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Park Young
Division Of Cardiology Department Of Internal Medicine College Of Medicine Seoul National University
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Chae In-ho
Cardiovascular Center Seoul National University Hospital
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Park Kyung
Cardiovascular Center And Department Of Internal Medicine Seoul National University Hospital
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Kim Hyo-soo
Cardiovascular Center And Department Of Internal Medicine Seoul National University Hospital
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Park K‐w
Jeju Self-government Province
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Cho Myeong-chan
Department Of Cardiology Chungbuk National University Hospital
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Cho Myeong-chan
Department Of Internal Medicine Chungbuk National University Hospital
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BAE Jang-Whan
Department of Internal Medicine, Chungbuk National University Hospital
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BAE Jang-Ho
Division of Cardiology, Konyang University Hospital
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Bae Jang-ho
Division Of Cardiology Konyang University Hospital
-
Bae Jang-whan
Department Of Internal Medicine Chungbuk National University Hospital
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Rha Seung-woon
Cardiovascular Center Korea University Guro Hospital
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Suh Jung-won
Cardiovascular Center Seoul National University Bundang Hospital
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