Oral anticoagulation with coumarin derivatives and antiplatelet effects of clopidogrel

Dirk Sibbing, Nicolas Von Beckerath, Tanja Morath, Julia Stegherr, Julinda Mehilli, Nikolaus Sarafoff, Siegmund Braun, Stefanie Schulz, Albert Schömig, Adnan Kastrati

Research output: Contribution to journalArticlepeer-review

79 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1205-1211
Number of pages7
JournalEuropean Heart Journal
Volume31
Issue number10
DOIs
StatePublished - May 2010

Keywords

  • Clopidogrel
  • Oral anticoagulation
  • Phenprocoumon
  • Platelet aggregation

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