A randomised determination of the Effect of Fluvastatin and Atorvastatin on top of dual antiplatelet treatment on platelet aggregation after implantation of coronary drug-eluting stents

Peter Wenaweser; Parham Eshtehardi; Linda Abrecht; Marcel Zwahlen; Kurt Schmidlin; Stephan Windecker; Bernhard Meier; Andre Haeberli; Otto M. Hess

doi:10.1160/TH09-11-0765

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2010; 104(03): 554-562
DOI: 10.1160/TH09-11-0765

Platelets and Blood Cells

Schattauer GmbH

A randomised determination of the Effect of Fluvastatin and Atorvastatin on top of dual antiplatelet treatment on platelet aggregation after implantation of coronary drug-eluting stents

The EFA-Trial

Peter Wenaweser^*

¹Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland

,

Parham Eshtehardi^*

¹Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland

,

Linda Abrecht

¹Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland

,

Marcel Zwahlen

³Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

⁴Clinical Trials Unit of the Inselspital, Bern University Hospital, and the Faculty of Medicine of the University of Bern, Bern, Switzerland

,

Kurt Schmidlin

³Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

⁴Clinical Trials Unit of the Inselspital, Bern University Hospital, and the Faculty of Medicine of the University of Bern, Bern, Switzerland

,

Stephan Windecker

¹Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland

,

Bernhard Meier

¹Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland

,

Andre Haeberli

²Department of Clinical Research, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland

,

Otto M. Hess

¹Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland

› Author Affiliations

Abstract

Summary

Drug-drug interaction between statins metabolised by cytochrome P450 3A4 and clopidogrel have been claimed to attenuate the inhibitory effect of clopidogrel. However, published data regarding this drug-drug interaction are controversial. We aimed to determine the effect of fluvastatin and atorvastatin on the inhibitory effect of dual anti-platelet therapy with acetylsalicylic acid (ASA) and clopidogrel. One hundred one patients with symptomatic stable coronary artery disease undergoing percutaneous coronary intervention and drug-eluting stent implantation were enrolled in this prospective randomised study. After an interval of two weeks under dual antiplatelet therapy with ASA and clopidogrel, without any lipid-lowering drug, 87 patients were randomised to receive a treatment with either fluvastatin 80 mg daily or atorvastatin 40 mg daily in addition to the dual antiplatelet therapy for one month. Platelet aggregation was assessed using light transmission aggregometry and whole blood impedance platelet aggregometry prior to randomisation and after one month of receiving assigned statin and dual antiplatelet treatment. Platelet function assessment after one month of statin and dual antiplatelet therapy did not show a significant change in platelet aggregation from 1^st to 2^nd assessment for either statin group. There was also no difference between atorvastatin and fluvastatin treatment arms. In conclusion, neither atorvastatin 40 mg daily nor fluvastatin 80 mg daily administered in combination with standard dual antiplatelet therapy following coronary drug-eluting stent implantation significantly interfere with the antiaggregatory effect of ASA and clopidogrel.

Keywords

Platelet aggregation - coronary stent - thrombosis - fluvastatin - atorvastatin - clopidogrel - acetylsalicylic acid

Full Text

References

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