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ȣ - 540558 282 |
| The effect of statin type on the platelet inhibition by clopidogrel : Post-hoc analysis of CILON-T (Influence of CILostazol based triple antiplatelet therapy ON ischemic complication after drug eluting stent implantation) trial |
| 서울대학교병원¹ ,분당서울대학교병원² ,고려대학교구로병원³ ,건양대학교병원⁴ ,충북대학교병원5 |
| 차명진¹, 서정원¹ ,² ,이승표¹ ,박경우¹ ,이해영¹ ,강현재¹ ,구본권¹ ,조영석¹ ,연태진¹ ,채인호² ,최동주² ,나승운³ ,배장호⁴ ,권택근⁴ ,배장환5 ,조명찬5 ,김효수¹ |
Background and Objectives: There have been controversy on the drug interaction between statins metabolized by cytochrome P450 3A4 (CYP3A4) and clopidogrel. Cilostazol is another antiplatelet agent metabolized by CYP3A4 and its interaction with CYP3A4-metabolized statin has not been reported. In this study, we aimed to determine the effect of rosuvastatin (non-CYP3A4 metabolized) and atorvastatin (CYP3A4 metabolized) on the inhibitory effect of dual (aspirin,clopidogrel) or triple (aspirin, clopidogrel, cilostazol) antiplatelet therapy in a post-hoc analysis of CILON-T trial.
Subjects and Methods: In randomized multicenter trial, total 915 patients who underwent coronary intervention with DES were randomized to receive dual or triple antiplatelet for six months. Stratification was performed according to the statin type (CYP3A4-metabolized vs. non-CYP3A4-metabolized). We included patients who took atorvastatin (20mg/day) or rosuvastatin (10mg/day) during the study period in this post-hoc analysis. Patients were categorized into four groups: group A (n=215, atorva+dual), group B (n=220, atrova+triple), group C (n=211, rosuva+dual) and group D (n=215, rosuva+triple). We compared the P2Y12 reaction unit (PRU) assessed with VerifyNowTM and lipid profile(mg/dL) among four groups at discharge and at six months after the index procedure.
Results: PRU showed difference according to the pattern of antiplatelet therapy, not by the pattern of co-administered statin type, both at discharge and at six months. Baseline lipid profile was not different among four groups. After six months, patients treated with rosuvastatin achieved lower LDL level than patients with atorvastatin, irrespective of the type of antiplatelet therapy. In addition, patients with TAT showed higher HDL and lower TG levels than patients with DAT, irrespective of the statin type.
Conclusion : Our findings demonstrated that the antiplatelet activity of clopidogrel and cilostazol were not influenced by statin type in patients treated with DES. Rosuvastatin (10mg/day) showed more LDL lowering action than atorvastatin (20mg/day) and using cilostazol on top of DAT seemed to have beneficial effect on lipid profiles.
Key word: Atorvastatin, Rosuvastatin, Clopidogrel, Cilostazol
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At discharge |
A (n=215) |
B (n=220) |
C (n=211) |
D (n=215) |
p |
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PRU T-Chol HDL TG LDL |
234.7(±80.9) 176.1(±43.3) 42.9(±11.2) 141.4 (±87.7) 107.9(±38.5) |
212.2(±94.0) 178.6(±37.2) 43.7(±11.1) 145.3(±81.4) 107.31(±32.2) |
228.4(±81.9) 177.1(±41.2) 45.2(±16.5) 144.2(±85.7) 107.3(±40.6) |
197.3(±85.6) 177.1(±41.2) 43.9(±14.9) 143.3(±84.3) 102.4(±36.8) |
<0.001 0.68 0.001 0.97 0.37 |
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Six months |
A (n=215) |
B (n=220) |
C (n=211) |
D (n=215) |
p |
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PRU T-Chol HDL TG LDL |
249.8 (±70.9) 132.2 (±27.7) 42.9(±10.7) 42.9(±10.7) 70.5(±21.2) |
205.1(±78.1) 133.7(±26.6) 46.9(±10.9) 133.7(±26.6) 67.4(±20.6) |
261.4(±76.9) 131.6(±30.4) 43.9(±10.9) 128.9(±80.6) 64.7(±21.7) |
214.5(±94.3) 130.4(±26.9) 46.3(±11.1) 112.8(±56.3) 64.7(±23.7) |
<0.001 0.69 0.001 0.01 0.03 |
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