Relation between stent thrombosis and calcium channel blocker after drug-eluting stent implantation

Nagano, Masahide; Hokimoto, Seiji; Nakao, Kōichi; Kaikita, Koichi; Akasaka, Tomonori; Ogawa, Hisao

doi:10.1016/j.jjcc.2014.11.013

Cited by 7 publications

(3 citation statements)

References 34 publications

(18 reference statements)

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“…A Japanese registry including DES-treated patients (n ¼ 3,493) showed that CCB use was significantly lower in patients with versus without stent thrombosis (25.0% vs. 51.4%; p ¼ 0.016). 27 In multiple regression analysis, the CCB use was a major negative predictor for the risk of stent thrombosis within 1 year (OR: 0.209; 95% CI: 0.045-0.973; p ¼ 0.046). A Taiwan registry including PCI-treated ACS patients (n ¼ 51,925) assessed the potential modification effect according to the compliance with clopidogrel.…”

Section: Discussionmentioning

confidence: 95%

Influence of Amlodipine on Haemostatic Measurements during Clopidogrel Treatment in Patients with Coronary Artery Disease

et al. 2019

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Amlodipine has a potential to reduce clopidogrel bioactivation through the cytochrome P450 3A4 enzyme in vivo, but the clinical impact of this interaction remains controversial. This randomized, open-label, two-period, crossover study was performed to evaluate the influence of amlodipine on the haemostatic profiles of high-risk patients during clopidogrel treatment. We recruited 40 Asian patients (Male/Female: n = 36/4) receiving clopidogrel (75 mg/day), aspirin (100 mg/day) and rosuvastatin for at least 6 months following percutaneous coronary intervention. Patients were randomly assigned to receive either 5 mg daily amlodipine or not for 2 weeks, and then were crossed over to the other treatment for 2 weeks. Haemostatic measurements were conducted with the VerifyNow assay and thromboelastography (TEG). Primary endpoint was P2Y12 Reaction Units (PRU) during on- versus off-amlodipine treatment. The on-amlodipine strategy showed higher level of PRU compared with the off-amlodipine strategy (176.8 ± 75.4 vs. 150.7 ± 65.5 PRU; ∆mean: 26.1 PRU; ∆95% confidence interval [CI]: 4.5–47.7 PRU; p = 0.019). Platelet-fibrin clot strength measured by TEG was lower during on- versus off-amlodipine treatment (7,712 ± 1,889 vs. 8,559 ± 2,174 dyne/cm2; ∆mean: –847 dyne/cm2; ∆95% CI: –1,632 to –62 dyne/cm2; p = 0.035). After amlodipine discontinuation, 27 patients (67.5%) showed a decrease in PRU, which was associated with ‘PRU ≥ 160 on-amlodipine’ in multivariate analysis (odds ratio: 62.014; 95% CI: 2.302–1670.328; p = 0.014). In conclusion, amlodipine increases platelet reactivity and decreases platelet-fibrin clot strength during clopidogrel treatment. In addition, the effect of amlodipine discontinuation on clopidogrel responsiveness is associated with on-amlodipine platelet reactivity.

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Section: Discussionmentioning

confidence: 95%

Influence of Amlodipine on Haemostatic Measurements during Clopidogrel Treatment in Patients with Coronary Artery Disease

et al. 2019

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“…Other DHB-CCBs, namely amlodipine and felodipine, also exerted non-significant protection, which suggests a potential group effect. Calcium ions are the major regulators of coagulation cascade, and previous evidence suggests that CCBs may have a protective association with stent thrombosis in coronary artery disease, 45 and vice versa, may potentiate the risk of GI bleeding in hypertensive patients. 46 However, the relationship between DHP CCBs and VTE has not been previously reported.…”

Section: Discussionmentioning

confidence: 99%

A pharmacoepidemiological nested case-control study of risk factors for venous thromboembolism with the focus on diabetes, cancer, socioeconomic group, medications, and comorbidities

Myllylahti,

Niskanen,

Lassila

et al. 2024

Diabetes and Vascular Disease Research

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Objectives A pharmacoepidemiological study to assess VTE risk factors in a diabetes-rich population. Methods The study comprised 299,590 individuals. We observed 3450 VTEs and matched them with 15,875 controls using a nested case-control approach and collected data on comorbidities and prescriptions. By multivariable conditional logistic regression, we calculated ORs with 95%CIs for comorbidities and medications to evaluate their associations with VTE. Results Diabetes (aOR 2.16; 95%CI 1.99–2.34), inflammatory bowel disease (1.84; 1.27–2.66), and severe psychiatric disorders (1.72; 1.43–2.05) had the strongest associations among the non-cancer comorbidities. Pancreatic (12.32; 7.11–21.36), stomach (8.57; 4.07–18.03), lung and bronchus (6.26; 4.16–9.43), and ovarian (6.72; 2.95–15.10) cancers were ranked as high-risk for VTE. Corticosteroids, gabapentinoids, psychotropic drugs, risedronic acid, and pramipexole were most strongly associated (aOR exceeding 1.5) with VTE. Insulin (3.86; 3.33–4.47) and sulphonylureas (2.62; 2.18–3.16) had stronger associations than metformin (1.65; 1.49–1.83). Statins and lercanidipine (0.78; 0.62–0.98) were associated with a lowered risk of VTE. Conclusions In this cohort, with 50% diabetes prevalence, pancreatic, stomach, lung and bronchus, and ovarian cancers were strongly associated with VTE. Corticosteroids, gabapentinoids, and psychotropic medications had the strongest associations with VTE among medications. This may be valuable for generating hypotheses for the further research. Lercanidipine may be a novel protective medication against VTE.

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“…The results showed that compared with placebo, patients receiving CCB treatment had signi cantly reduced incidence of restenosis and clinical events. Nagano M et al [22] in a Japanese KICS study found that the use of CCB may be associated with a reduced risk of Stent thrombosis(ST) within 1 year after drug-eluting stent (DES) placement. The 2019 European Guidelines for the Diagnosis and Management of Chronic Coronary Syndrome also advocate the use of CCB for initial treatment [23] .…”

Section: Introductionmentioning

confidence: 99%

Correlation and clinical significance of calcium channel blocker therapy for in-stent restenosis after percutaneous coronary intervention

Chen

Guo

et al. 2022

Preprint

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Background In-stent restenosis (ISR) is one of major complications after percutaneous coronary intervention (PCI) in patients with coronary artery disease(CAD). The prevention and treatment of ISR is not well established yet. This study explored the correlation and clinical significance of calcium channel blockers(CCB) and ISR . Methods Patients who received coronary angiography(CAG) after PCI in Department of Cardiology, The Third Clinical Medical College of Shanxi Medical University from November 2019 to April 2022 were collected, and the relationship between calcium channel blockers taken by patients before PCI and the occurrence time of in-stent restenosis as well as the severity of restenosis was analyzed. Chi-square test or t test, pearson correlation regression analysis and logistic regression analysis were conducted . Results The in-stent restenosis group (ISR group) and the non-stent restenosis group (no-ISR group) had significant differences in diabetes, previous myocardial infarction history, red blood cell distribution width, fasting blood glucose, ACC/AHA lesion classification, stent maximum diameter, total stent length, and stent expansion pressure (all P < 0.05). Patients with ISR had higher levels of total cholesterol, triglycerides, homocysteine(Hcy) and D- dimer in the preoperative oral calcium channel blocker group (CCBs group) than in the non-oral calcium channel blocker group (no-CCBs group). Moreover, the maximum balloon dilatation pressure and the degree of ISR in the CCBs group were lower, and the time interval for ISR was longer (all P < 0.05). Among the ISR patients with Hcy ≥ 10µmol/L, the no-CCBs group had lower levels of peripheral blood total cholesterol, triglycerides, Hcy and D-dimer, larger maximum balloon dilatation pressure and ISR, and a shorter time interval for ISR (P < 0.05). Conclusion The use of CCB has a direct correlation with the incidence, interval and severity of ISR. The use of CCB may delay the occurrence time of in-stent restenosis after PCI in patients, providing new ideas for the prevention and treatment strategies of ISR.

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Relation between stent thrombosis and calcium channel blocker after drug-eluting stent implantation

Abstract: These results suggest that CCB use may be associated with a decreased risk of ST after DES implantation within 1 year in Japanese patients.

Cited by 7 publications

References 34 publications

Influence of Amlodipine on Haemostatic Measurements during Clopidogrel Treatment in Patients with Coronary Artery Disease

Influence of Amlodipine on Haemostatic Measurements during Clopidogrel Treatment in Patients with Coronary Artery Disease

A pharmacoepidemiological nested case-control study of risk factors for venous thromboembolism with the focus on diabetes, cancer, socioeconomic group, medications, and comorbidities

Correlation and clinical significance of calcium channel blocker therapy for in-stent restenosis after percutaneous coronary intervention

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