Abstract 4306: Simultaneous Administration of High Dose Atorvastatin and Clopidogrel Loading Doses Does Not Interfere With Platelet Inhibition During Percutaneous Coronary Intervention
Background: Reloading with high doses of statins shortly before percutaneous coronary interventions (PCI) has recently been proposed as a strategy to reduce periprocedural myonecrosis. There has been concern that statins that are metabolized by cytochrome P450 3A4 may interfere with clopidogrel metabolism at high doses. The impact of simultaneous administration of high doses of atorvastatin and clopidogrel on the efficacy of platelet inhibition has not been established.
Methods: We randomized 44 patients who were undergoing elective PCI to receive atorvastatin 80mg together with clopidogrel 600mg loading dose (n=20) vs. clopidogrel 600mg alone (n=24) at the time of PCI. Platelet aggregation was measured at baseline, 4 hours after clopidogrel loading dose and 18 –24 hours after clopidogrel loading dose by light transmittance aggregometry using ADP 10μM as agonist.
Results: Platelet aggregation was similar at baseline in both the atorvastatin and the control group (57±15% vs. 58±21%; p=0.86). There was no significant difference in platelet aggregation between the atorvastatin and control group at 4 hours (36.6±18% vs. 32.8±21%; p=0.54) and 24 hours post clopidogrel loading dose (32.6±16% vs. 34.9±18%; p=0.67).
Conclusion: High dose atorvastatin given simultaneously with clopidogrel loading dose at the time of PCI does not alter platelet inhibition by clopidogrel. Statin reloading with high doses of atorvastatin at the time of PCI appears to be a safe strategy to reduce periprocedural myonecrosis without adverse effects on platelet inhibition by clopidogrel.