Calcium-Channel Blockers Reduce the Antiplatelet Effect of Clopidogrel
Jolanta M. Siller-Matula, MD*,
Irene Lang, MD ,
Guenter Christ, MD and
Bernd Jilma, MD*,*
* Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
Department of Cardiology, Medical University of Vienna, Vienna, Austria
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Figure 1 Distribution of the PRI
Patients were on a regimen of clopidogrel therapy (n = 200), and healthy volunteers were drug free (n = 20). The dotted line represents the lower limit of the normal range of the vasodilator-stimulated phosphoprotein assay (69% platelet reactivity index [PRI]).
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Figure 2 Negative Interaction Between CCBs and Clopidogrel
(A) The platelet reactivity index (PRI) in the vasodilator-stimulated phosphoprotein phosphorylation assay and (B) adenosine diphosphate (ADP)-induced platelet aggregation in patients with or without calcium-channel blocker (CCB) treatment are shown. Data are presented as mean and 95% confidence intervals. *p = 0.046, **p = 0.001; patients treated with CCBs compared with patients not treated with CCBs.
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Figure 3 Distribution of the PRI With or Without Calcium-Channel Blockers
Distribution of the platelet reactivity index (PRI) in patients with or without calcium-channel blocker treatment is shown. The dotted line represents the lower limit of the normal range of the vasodilator-stimulated phosphoprotein assay (69% PRI).
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Figure 4 Cumulative Kaplan-Meier Estimates of Composite End Point
Cumulative Kaplan-Meier estimates of the rates of the composite end point during the 6-month follow-up period. Blue line = patients without calcium-channel blocker; red line = patients with calcium-channel blocker. Crude hazard ratio = 3.9; p = 0.001; 95% confidence interval 1.7 to 8.5; adjusted hazard ratio = 3.5; p = 0.005; 95% confidence interval 1.4 to 8.6.
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