Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
J Cardiovasc Pharmacol Ther. 2024 Jan-Dec;29:10742484241298150. doi: 10.1177/10742484241298150.
Calcium channel blockers (CCBs) are frequently co-administered with clopidogrel in cardiovascular disease. Although an inhibitory drug interaction exists between them, comprehensive large-scale studies for its validation are lacking. We investigated interactions between CCBs and clopidogrel using a large-scale national registry of patients who underwent percutaneous coronary intervention (PCI). The Platelet function and genoType-Related long-term Prognosis-Platelet Function Test consortium investigates the association between platelet function test and long-term prognosis during dual antiplatelet therapy including clopidogrel in patients using drug-eluting stents. We compared the platelet reactivity using the VerifyNow P2Y12 test and clinical outcomes between CCB users and non-users. Between 2003 and 2018, 11 714 patients were enrolled and categorized into two groups according to CCB usage. A composite endpoint encompassing all-cause mortality, myocardial infarction, stent thrombosis, or stroke was defined as a major adverse cardiac and cerebrovascular event (MACCE). During the 5-year follow-up period, no significant differences were observed in P2Y12 reaction units (215.8 ± 84.7 vs 218.4 ± 76.7, = .156), MACCEs, major bleeding, or high platelet reactivity rates, even after adjusting for propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). When limited to the high platelet reactivity cohort (≥252 PRU), the results remained consistent for MACCE [PSM-adjusted, HR: 0.923 (0.644-1.323), -value .663; IPTW-adjusted, HR: 1.300 (0.822-2.056), -value .262]. CCB and clopidogrel co-administration does not appear to significantly impact clopidogrel responsiveness or clinical outcomes. Despite these promising results, further investigation may be warranted. Platelet Function and genoType-Related Long-term progGosis in DES-treated Patients: A Consortium From Multi-centered Registries [PTRG-DES]; NCT04734028.
钙通道阻滞剂（CCBs）在心血管疾病中常与氯吡格雷联合使用。尽管它们之间存在抑制性药物相互作用，但缺乏全面的大规模研究来验证。我们使用接受经皮冠状动脉介入治疗（PCI）的患者的大型国家注册研究来研究 CCB 和氯吡格雷之间的相互作用。血小板功能和基因型相关的长期预后-血小板功能测试联合研究（PTRG-DES）调查了在使用药物洗脱支架的患者中，包括氯吡格雷在内的双联抗血小板治疗期间血小板功能测试与长期预后之间的关联。我们比较了 CCB 使用者和非使用者的 VerifyNow P2Y12 测试血小板反应性和临床结局。在 2003 年至 2018 年间，共纳入 11714 例患者，并根据 CCB 使用情况分为两组。将全因死亡率、心肌梗死、支架血栓形成或卒中的复合终点定义为主要不良心脏和脑血管事件（MACCE）。在 5 年的随访期间，在 P2Y12 反应单位（215.8±84.7 与 218.4±76.7，=0.156）、MACCE、大出血或高血小板反应率方面，两组间无显著差异，甚至在进行倾向评分匹配（PSM）和逆概率处理加权（IPTW）后也是如此。当限制在高血小板反应性队列（≥252 PRU）时，MACCE 的结果仍然一致[PSM 调整后，HR：0.923（0.644-1.323），值.663；IPTW 调整后，HR：1.300（0.822-2.056），值.262]。CCB 和氯吡格雷联合使用似乎不会显著影响氯吡格雷的反应性或临床结局。尽管有这些有希望的结果，但可能需要进一步研究。多中心注册中心的血小板功能和基因型相关长期预后联盟（PTRG-DES）在 DES 治疗患者中的研究：NCT04734028。
