Wang Chen-Yu, Lin Zhen-Fang, Lee Chii-Ming, Tsai Yi-Wen, Huang Ting-Ying, Shen Li-Jiuan, Hsiao Fei-Yuan
Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Pharmacoepidemiol Drug Saf. 2017 Mar;26(3):229-238. doi: 10.1002/pds.4147. Epub 2017 Jan 9.
Existing studies suggested that concomitant use of calcium channel blockers (CCBs) may interfere with the antiplatelet effect of clopidogrel. The objective of this study was to examine the effect of concomitant use of CCBs and clopidogrel on risks of acute coronary syndrome (ACS) re-hospitalization in patients receiving percutaneous coronary intervention.
Using the Taiwan National Health Insurance Research Database, we identified 51 925 patients who were admitted for newly diagnosed ACS, received percutaneous coronary intervention, and used clopidogrel within 1 year after discharge. We further stratified them into three groups based on their uses of guideline-recommended secondary prevention medications for ACS (fully, partially, and non-compliant groups) to assess the potential modification effect of guideline compliance. For each group, we conducted a 1:1 propensity score matching to minimize selection bias. Cox proportional hazard models were used to investigate the effect of concomitant use of CCBs (overall, subclasses, and individual CCBs) and clopidogrel on risks of ACS re-hospitalization.
Concomitant use of CCBs in patients discharged with clopidogrel was significantly associated with a lower risk of ACS re-hospitalization in the fully compliant group (HR = 0.82 [95% confidence interval 0.75-0.89], p < 0.001) but was associated with increased risk of ACS re-hospitalization in the non-compliant group (HR = 1.22 [1.03-1.45], p = 0.0252).
Different guideline compliance of secondary prevention medications could modify the potential drug-drug interaction between clopidogrel and CCBs. Concomitant use of CCBs and clopidogrel was significantly associated with increased risk of ACS re-hospitalization in ACS patients not compliant to guideline-recommended secondary prevention drugs. Copyright © 2017 John Wiley & Sons, Ltd.
现有研究表明，同时使用钙通道阻滞剂（CCB）可能会干扰氯吡格雷的抗血小板作用。本研究的目的是探讨在接受经皮冠状动脉介入治疗的患者中，同时使用CCB和氯吡格雷对急性冠状动脉综合征（ACS）再次住院风险的影响。
利用台湾国民健康保险研究数据库，我们确定了51925例因新诊断的ACS入院、接受经皮冠状动脉介入治疗且在出院后1年内使用氯吡格雷的患者。我们根据他们对ACS指南推荐的二级预防药物的使用情况，将他们进一步分为三组（完全、部分和不依从组），以评估指南依从性的潜在修正作用。对于每组，我们进行1:1倾向评分匹配，以尽量减少选择偏倚。使用Cox比例风险模型研究同时使用CCB（总体、亚类和个体CCB）和氯吡格雷对ACS再次住院风险的影响。
在完全依从组中，出院时同时使用CCB的患者ACS再次住院风险显著降低（HR = 0.82 [95%置信区间0.75 - 0.89]，p < 0.001），但在不依从组中，这与ACS再次住院风险增加相关（HR = 1.22 [1.03 - 1.45]，p = 0.0252）。
二级预防药物不同的指南依从性可能会改变氯吡格雷与CCB之间潜在的药物相互作用。在不依从指南推荐的二级预防药物的ACS患者中，同时使用CCB和氯吡格雷与ACS再次住院风险增加显著相关。版权所有© 2017约翰威立父子有限公司。
