TY - JOUR
T1 - Oral anticoagulation with coumarin derivatives and antiplatelet effects of clopidogrel
AU - Sibbing, Dirk
AU - Von Beckerath, Nicolas
AU - Morath, Tanja
AU - Stegherr, Julia
AU - Mehilli, Julinda
AU - Sarafoff, Nikolaus
AU - Braun, Siegmund
AU - Schulz, Stefanie
AU - Schömig, Albert
AU - Kastrati, Adnan
PY - 2010/5
Y1 - 2010/5
N2 - AimsA 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 resultsPatients (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.
AB - AimsA 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 resultsPatients (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.
KW - Clopidogrel
KW - Oral anticoagulation
KW - Phenprocoumon
KW - Platelet aggregation
UR - http://www.scopus.com/inward/record.url?scp=77952400164&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehq023
DO - 10.1093/eurheartj/ehq023
M3 - Article
C2 - 20159881
AN - SCOPUS:77952400164
SN - 0195-668X
VL - 31
SP - 1205
EP - 1211
JO - European Heart Journal
JF - European Heart Journal
IS - 10
ER -