1
|
Pontis A, Delavenne X, Verdier MC, Hodin S, Andriamaharo A, Gueret P, Nedelec-Gac F, Bachelot-Loza C, Gaussem P, Gouin-Thibault I. Impact of age on in vitro metabolism of clopidogrel: a potential explanation for high on-treatment platelet reactivity in the elderly? Res Pract Thromb Haemost 2023; 7:100014. [PMID: 36891520 PMCID: PMC9986101 DOI: 10.1016/j.rpth.2022.100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/07/2022] [Indexed: 01/08/2023] Open
Abstract
Background High on-treatment platelet reactivity has been reported in 30% of patients on clopidogrel and 50% in elderly patients; however, little is known about the mechanisms of this biological resistance. One hypothesis is an age-related impaired hepatic metabolism of the prodrug clopidogrel, leading to a lower formation of its active metabolite (clopidogrel-AM). Objectives To compare the levels of clopidogrel-AM formed in vitro using "old" and "young" human liver microsomes (HLMs) and their consequences on platelet functions. Methods We developed an in vitro model using "old" (73.6 ± 2.3 years) and "young" (51.2 ± 8.5 years) HLMs, added to platelet-rich plasma from 21 healthy donors with or without clopidogrel (50 μM) and incubated at 37 °C for 30 (T30) and 45 minutes (T45). Clopidogrel-AM was quantified by liquid chromatography-mass spectrometry/mass spectrometry method. Platelet aggregation was performed by light transmission aggregometry. Results The generation of clopidogrel-AM increased over time and reached concentrations comparable with those reported in treated patients. At T30, mean clopidogrel-AM concentrations were significantly higher with "young" (8.56 μg/L; 95% CI, 5.87-11.24) than with "old" HLMs (7.64 μg/L; 95% CI, 5.14-10.14; P = .002); and at T45, 11.40 μg/L; 95% CI (7.57-15.22) vs 10.63 μg/L, 95% CI (7.10-14.15), P = .02 (n = 21). Despite a significant inhibition of platelet aggregation, no significant difference was found in light transmission aggregometry (adenosine diphosphate, 10 μM) after clopidogrel metabolism by "old" or "young" HLMs, probably because of low sensitivity of the method to small variations of clopidogrel-AM. Conclusion In this original model combining metabolic and functional approaches, less clopidogrel-AM was produced with HLMs from older patients. This provides support for a decreased CYP450 activity that may contribute to high on-treatment platelet reactivity in elderly patients.
Collapse
Affiliation(s)
- Adeline Pontis
- Laboratoire d'Hématologie, Pontchaillou University Hospital, Rennes, France
- INSERM, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, University of Rennes, Rennes, France
| | - Xavier Delavenne
- Laboratoire de Pharmacologie Toxicologie, Saint-Etienne University Hospital, Saint-Etienne, France
- INSERM, UMR_S1059, Université de Lyon, Saint-Etienne, France
| | - Marie-Clémence Verdier
- INSERM, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, University of Rennes, Rennes, France
- Laboratoire de Pharmacologie Clinique, Pontchaillou University Hospital, Rennes, France
| | - Sophie Hodin
- Laboratoire de Pharmacologie Toxicologie, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Annie Andriamaharo
- Laboratoire de Pharmacologie Clinique, Pontchaillou University Hospital, Rennes, France
| | - Pierre Gueret
- Laboratoire d'Hématologie, Pontchaillou University Hospital, Rennes, France
| | | | | | - Pascale Gaussem
- Université de Paris Cité, Innovative Therapies in Haemostasis, INSERM UMR_S1140, Paris, France
- Service d'Hématologie Biologique, AP-HP, Université de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Isabelle Gouin-Thibault
- Laboratoire d'Hématologie, Pontchaillou University Hospital, Rennes, France
- INSERM, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, University of Rennes, Rennes, France
- Correspondence Isabelle Gouin-Thibault, Laboratoire d'Hématologie, Pontchaillou University Hospital, INSERM, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, University of Rennes, 35000, Rennes, France.
| |
Collapse
|
2
|
Norris JW, Watson JL, Tablin F, Kozikowski TA, Knych HK. Pharmacokinetics and competitive pharmacodynamics of ADP-induced platelet activation after oral administration of clopidogrel to horses. Am J Vet Res 2019; 80:505-512. [PMID: 31034271 DOI: 10.2460/ajvr.80.5.505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine pharmacokinetics and pharmacodynamics after oral administration of a single dose of clopidogrel to horses. ANIMALS 6 healthy adult horses. PROCEDURES Blood samples were collected before and at various times up to 24 hours after oral administration of clopidogrel (2 mg/kg). Reactivity of platelets from each blood sample was determined by optical aggregometry and phosphorylation of vasodilator-stimulated phosphoprotein (VASP). Concentrations of clopidogrel and the clopidogrel active metabolite derivative (CAMD) were measured in each blood sample by use of liquid chromatography-tandem mass spectrometry, and pharmacokinetic parameters were determined with a noncompartmental model. RESULTS Compared with results for preadministration samples, platelet aggregation in response to 12.5μM ADP decreased significantly within 4 hours after clopidogrel administration for 5 of 6 horses. After 24 hours, platelet aggregation was identical to that measured before administration. Platelet aggregation in response to 25μM ADP was identical between samples obtained before and after administration. Phosphorylation of VASP in response to ADP (20μM) and prostaglandin E1 (3.3μM) was also unchanged by administration of clopidogrel. Time to maximum concentration of clopidogrel and CAMD was 0.54 and 0.71 hours, respectively, and calculated terminal-phase half-life of clopidogrel and CAMD was 1.81 and 0.97 hours, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Clopidogrel or CAMD caused competitive inhibition of ADP-induced platelet aggregation during the first 24 hours after clopidogrel administration. Because CAMD was rapidly eliminated from horses, clopidogrel administration may be needed more frequently than in other species in which clopidogrel causes irreversible platelet inhibition. (Am J Vet Res 2019;80:505-512).
Collapse
|
3
|
Mallouk N, Varvat J, Berger A, Epinat M, Accassat S, Garcin A, Montmartin A, Li G, Garnier P, Mismetti P, Lambert C. Assessment of a flow cytometry technique for studying signaling pathways in platelets: Monitoring of VASP phosphorylation in clinical samples. Pract Lab Med 2018; 11:10-18. [PMID: 30202779 PMCID: PMC6128249 DOI: 10.1016/j.plabm.2018.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 02/15/2018] [Accepted: 02/15/2018] [Indexed: 12/12/2022] Open
Abstract
A recently released kit (PerFix EXPOSE) was reported to improve the measurement of the degree of phosphorylation of proteins in leukocytes by flow cytometry. We tested its adaptation for platelets to monitor vasodilator-stimulated phosphoprotein (VASP) phosphorylation, which is the basis of a currently used test for the assessment of the pharmacological response to P2Y12 antagonists (PLT VASP/P2Y12). The PerFix EXPOSE kit was compared to the PLT VASP/P2Y12 kit by using blood samples drawn at 24 h post clopidogrel dose from 19 patients hospitalized for a non-cardio-embolic ischemic stroke and treated with clopidogrel monotherapy for at least five days in an observational study. The platelet PerFix method was based on adaptation of the volume of the sample, the centrifugation speed and the incubation temperature. Poor agreement between prevention by adenosine diphosphate (ADP) of PGE1-induced cAMP-mediated VASP phosphorylation and ADP induced aggregation assessed by Light Transmittance Aggregometry was found. We found a significant correlation between the PLT VASP/P2Y12 kit and the PerFix EXPOSE kit. The PerFix EXPOSE kit may also be helpful to monitor adverse effects of second-generation tyrosine kinase inhibitors on platelets.
Collapse
Affiliation(s)
- N Mallouk
- Unité de Médecine Vasculaire et Thérapeutiques, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France.,Centre de Microscopie Electronique Stéphanois (CMES), Université Jean Monnet, Saint-Etienne, France
| | - J Varvat
- Unité Neuro-vasculaire CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - A Berger
- Laboratoire d'Immunologie Clinique CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France.,GIMAP EA3064, Saint-Etienne, France
| | - M Epinat
- Unité Neuro-vasculaire CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France.,SAnté INgéniérie BIOlogie St-Etienne (SAINBIOSE), Université Jean Monnet, Saint-Etienne, France
| | - S Accassat
- Unité de Médecine Vasculaire et Thérapeutiques, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - A Garcin
- Unité de Recherche Clinique Innovation et Pharmacologie (URCIP), CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - A Montmartin
- SAnté INgéniérie BIOlogie St-Etienne (SAINBIOSE), Université Jean Monnet, Saint-Etienne, France
| | - G Li
- Service d'Urologie, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - P Garnier
- Unité Neuro-vasculaire CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - P Mismetti
- Unité de Médecine Vasculaire et Thérapeutiques, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France.,SAnté INgéniérie BIOlogie St-Etienne (SAINBIOSE), Université Jean Monnet, Saint-Etienne, France
| | - C Lambert
- Laboratoire d'Immunologie Clinique CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France.,CNRS-UMR 5148-Ecole Nationale Supérieure des Mines de St Etienne (ENSM), Saint-Etienne, France
| |
Collapse
|
4
|
Koziński M, Ostrowska M, Adamski P, Sikora J, Sikora A, Karczmarska-Wódzka A, Marszałł MP, Boinska J, Laskowska E, Obońska E, Fabiszak T, Kubica J. Which platelet function test best reflects the in vivo plasma concentrations of ticagrelor and its active metabolite? The HARMONIC study. Thromb Haemost 2016; 116:1140-1149. [PMID: 27628615 DOI: 10.1160/th16-07-0535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/24/2016] [Indexed: 12/21/2022]
Abstract
Aim of this study was assessment of the relationship between concentrations of ticagrelor and its active metabolite (AR-C124910XX) and results of selected platelet function tests. In a single-centre, cohort study, patients with myocardial infarction underwent blood sampling following a 180 mg ticagrelor loading dose intake (predose, 1, 2, 3, 4, 6, 12, 24 hours postdose) to perform pharmacokinetic and pharmacodynamic assessments. Platelet reactivity was evaluated using the VASP-assay, the VerifyNow device and the Multiplate analyzer. Analysis of 36 patients revealed high negative correlations between ticagrelor concentrations and platelet reactivity evaluated with all three platelet function tests (the VASP-assay: RS=-0.722; p<0.0001; the VerifyNow device: RS=-0.715; p<0.0001; the Multiplate analyzer: RS=-0.722; p<0.0001), with no significant differences between correlation coefficients. Similar results were found for AR-C124910XX. Platelet reactivity values assessed with all three methods generally correlated well with each other; however, a significantly higher correlation (p<0.02) was demonstrated between the VerifyNow and Multiplate tests (RS=0.707; p<0.0001) than in other assay combinations (the VASP-assay and the VerifyNow device: RS=0.595; p<0.0001; the VASP-assay and the Multiplate analyzer: RS=0.588; p<0.0001). With respect to the recognition of high platelet reactivity, we found higher measurement concordance between the VerifyNow and Multiplate tests compared with other assay combinations, while for low platelet reactivity, only results of the VerifyNow and Multiplate assay were related to each other. Platelet reactivity measurements performed with the VASP, VerifyNow and Multiplate tests show comparably strong negative correlations with ticagrelor and AR-C124910XX concentrations.
Collapse
Affiliation(s)
- Marek Koziński
- Marek Koziński, Department of Principles of Clinical Medicine, Collegium Medicum, Nicolaus Copernicus University, 9 Skłodowskiej-Curie Street, Bydgoszcz 85-094, Poland, Tel.: +48 52 5854023, Fax: +48 52 5854024, E-mail:
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Danese E, Fava C, Beltrame F, Tavella D, Calabria S, Benati M, Gelati M, Gottardo R, Tagliaro F, Guidi GC, Cattaneo M, Minuz P. Relationship between pharmacokinetics and pharmacodynamics of clopidogrel in patients undergoing percutaneous coronary intervention: comparison between vasodilator-stimulated phosphoprotein phosphorylation assay and multiple electrode aggregometry. J Thromb Haemost 2016; 14:282-93. [PMID: 26576037 DOI: 10.1111/jth.13197] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/08/2015] [Indexed: 12/30/2022]
Abstract
UNLABELLED ESSENTIALS: The reliability of platelet tests as markers of the variable bioavailability of clopidogrel is not yet defined. Kinetics of clopidogrel active metabolite (CAM) and platelet response were studied in ischemic heart disease. CAM plasma maximum concentration (Cmax ) predicted vasodilator-stimulated phosphoprotein (VASP-P). Timely performed VASP-P, not an aggregation-based test, may be a surrogate for clopidogrel bioavailability. BACKGROUND The high inter-individual variability in the inhibition of platelet function by clopidogrel is mostly explained by high variability in its transformation to an active metabolite (CAM). Objective We investigated the relations between pharmacokinetics and pharmacodynamics of CAM by comparing two methods of platelet function. METHODS We enrolled 14 patients undergoing percutaneous coronary interventions for non-ST-segment elevation acute coronary syndrome or inducible myocardial ischemia. Plasma concentrations of clopidogrel and CAM, phosphorylation of vasodilator-stimulated phosphoprotein (VASP-P), expressed as a platelet reactivity index (PRI) and whole-blood platelet aggregation (multiple electrode aggregometer, MEA) were measured before and after a 600-mg clopidogrel loading dose (nine time-points) and before and after 75-mg maintenance doses on days 2, 7 and 30. RESULTS Plasma concentrations of clopidogrel and CAM were highly variable. CAM reached maximal concentration (Cmax ) (median, 110.8 nm; range, 41.9-484.8) 0.5-2 h after the loading dose. A sigmoid dose-response curve defined the relations between CAMCmax and PRI after 3 to 24 h (IC50 , 459.6 nm; 95% confidence interval, 453.4-465.7; R(2) = 0.82). PRI was unchanged from baseline in patients with the lowest CAMCmax (< 83 nm, n = 7), indicating low sensitivity of VASP-P. PRI values were also predicted by CAMCmax at days 2, 7 and 30. Platelet aggregation measured by MEA did not show significant relations with either PRI or with CAM pharmacokinetics at any time-point. CONCLUSIONS After 600 mg clopidogrel, VASP-P, but not whole-blood platelet aggregation measured by MEA, is almost entirely predicted by CAMCmax . VASP-P could be useful in studies aimed at investigating relations between CAM bioavailability and clinical events.
Collapse
Affiliation(s)
- E Danese
- Section of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
- Section of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - C Fava
- Section of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - F Beltrame
- Division of Cardiology, AOUI Verona, Verona, Italy
| | - D Tavella
- Division of Cardiology, AOUI Verona, Verona, Italy
| | - S Calabria
- Section of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - M Benati
- Section of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - M Gelati
- Section of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - R Gottardo
- Unit of Forensic Medicine, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - F Tagliaro
- Unit of Forensic Medicine, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - G C Guidi
- Section of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - M Cattaneo
- Unità di Medicina 3, Ospedale San Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - P Minuz
- Section of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy
| |
Collapse
|
6
|
Chhonker YS, Pandey CP, Chandasana H, Laxman TS, Prasad YD, Narain VS, Dikshit M, Bhatta RS. Simultaneous quantitation of acetylsalicylic acid and clopidogrel along with their metabolites in human plasma using liquid chromatography tandem mass spectrometry. Biomed Chromatogr 2015; 30:466-73. [PMID: 26230053 DOI: 10.1002/bmc.3573] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 07/14/2015] [Accepted: 07/23/2015] [Indexed: 11/06/2022]
Abstract
The interest in therapeutic drug monitoring has increased over the last few years. Inter- and intra-patient variability in pharmacokinetics, plasma concentration related toxicity and success of therapy have stressed the need of frequent therapeutic drug monitoring of the drugs. A sensitive, selective and rapid liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) method was developed for the simultaneous quantification of acetylsalicylic acid (aspirin), salicylic acid, clopidogrel and carboxylic acid metabolite of clopidogrel in human plasma. The chromatographic separations were achieved on Waters Symmetry Shield(TM) C18 column (150 × 4.6 mm, 5 µm) using 3.5 mm ammonium acetate (pH 3.5)-acetonitrile (10:90, v/v) as mobile phase at a flow rate of 0.75 mL/min. The present method was successfully applied for therapeutic drug monitoring of aspirin and clopidogrel in 67 patients with coronary artery disease.
Collapse
Affiliation(s)
- Yashpal S Chhonker
- Pharmacokinetics and Metabolism Division, CSIR - Central Drug Research Institute, Lucknow, 226031, India.,Academy of Scientific and Innovative Research, Anusandhan Bhawan, Rafi Marg, New Delhi, 110 001, India
| | - Chandra P Pandey
- Pharmacology Division, CSIR - Central Drug Research Institute, Lucknow, 226031, India.,Department of Cardiology, King George's Medical University, Lucknow, 226001, India
| | - Hardik Chandasana
- Pharmacokinetics and Metabolism Division, CSIR - Central Drug Research Institute, Lucknow, 226031, India.,Academy of Scientific and Innovative Research, Anusandhan Bhawan, Rafi Marg, New Delhi, 110 001, India
| | - Tulsankar Sachin Laxman
- Pharmacokinetics and Metabolism Division, CSIR - Central Drug Research Institute, Lucknow, 226031, India.,Academy of Scientific and Innovative Research, Anusandhan Bhawan, Rafi Marg, New Delhi, 110 001, India
| | - Yarra Durga Prasad
- Pharmacokinetics and Metabolism Division, CSIR - Central Drug Research Institute, Lucknow, 226031, India.,Academy of Scientific and Innovative Research, Anusandhan Bhawan, Rafi Marg, New Delhi, 110 001, India
| | - V S Narain
- Department of Cardiology, King George's Medical University, Lucknow, 226001, India
| | - Madhu Dikshit
- Pharmacology Division, CSIR - Central Drug Research Institute, Lucknow, 226031, India
| | - Rabi S Bhatta
- Pharmacokinetics and Metabolism Division, CSIR - Central Drug Research Institute, Lucknow, 226031, India.,Academy of Scientific and Innovative Research, Anusandhan Bhawan, Rafi Marg, New Delhi, 110 001, India
| |
Collapse
|
7
|
Gorog DA, Jeong YH. Platelet function tests: why they fail to guide personalized antithrombotic medication. J Am Heart Assoc 2015; 4:JAHA.115.002094. [PMID: 26015325 PMCID: PMC4599433 DOI: 10.1161/jaha.115.002094] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Diana A Gorog
- Imperial College, London, United Kingdom (D.A.G.) University of Hertfordshire, United Kingdom (D.A.G.)
| | - Young-Hoon Jeong
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Korea (Y.H.J.)
| |
Collapse
|
8
|
Liang Y, Johnston M, Hirsh J, Pare G, Li C, Mehta S, Teo KK, Sloane D, Yi Q, Zhu J, Eikelboom JW. Relation between clopidogrel active metabolite levels and different platelet aggregation methods in patients receiving clopidogrel and aspirin. J Thromb Thrombolysis 2013; 34:429-36. [PMID: 22797934 DOI: 10.1007/s11239-012-0762-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Clopidogrel is a prodrug that undergoes bioconversion via cytochrome P450 system to form an active metabolite (AM) that binds to the platelet ADP receptor. The antiplatelet effect of clopidogrel is commonly assessed by measuring the aggregatory response to 5 μM ADP by light transmission aggregation (LTA) or multiple electrode aggregometry (MEA) or by the vasodilator-stimulated phosphoprotein platelet reactivity index (VASP-PRI). To determine which of these three tests of platelet ADP receptor pathway inhibition most closely correlates with clopidogrel AM levels. We analyzed blood samples from 82 patients with coronary artery disease who were randomized to receive double-dose or standard dose clopidogrel for 2 weeks. We measured peak clopidogrel AM levels, platelet aggregation in response to ADP and VASP-PRI on days 1, and repeated all the measures on days 7 and 14. Linear regression analysis was used to examine the correlation between clopidogrel AM and LTA, MEA and VASP-PRI. Bland-Altman plots were used to explore the agreement between tests of the antiplatelet effects of clopidogrel. Clopidogrel AM on day 1 correlated most closely with VASP-PRI (r = -0.5767) and demonstrated weaker correlations with LTA (r = -0.4656) and MEA (r = -0.3384) (all p < 0.01). Intra-class correlation (ICC) between VASP-PRI and LTA was 0.6446; VASP-PRI and MEA was 0.4720; and LTA and MEA was 0.4693. Similar results were obtained on days 7 and 14. Commonly used pharmacodynamic measures of clopidogrel response are only moderately correlated with clopidogrel AM levels and may not be suitable to measure the adequacy of clopidogrel therapy.
Collapse
Affiliation(s)
- Yan Liang
- Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Delavenne X, Magnin M, Basset T, Piot M, Mallouk N, Ressnikoff D, Garcin A, Laporte S, Garnier P, Mismetti P. Investigation of drug-drug interactions between clopidogrel and fluoxetine. Fundam Clin Pharmacol 2013; 27:683-9. [PMID: 23413998 DOI: 10.1111/fcp.12021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/12/2013] [Accepted: 01/22/2013] [Indexed: 11/28/2022]
Abstract
Drug-drug interactions may contribute to the variability of the response of clopidogrel. Several hypotheses have been proposed concerning the potential modification of clopidogrel pharmacokinetics and pharmacodynamics by fluoxetine. This open-label crossover study assessed the effect of fluoxetine on the pharmacological activity of clopidogrel in healthy volunteers. Eight healthy male volunteers received a single 600-mg loading dose of clopidogrel followed by 20 mg of fluoxetine on 4 days and then 20 mg of fluoxetine plus 600 mg of clopidogrel on the fifth day. Eleven blood samples were withdrawn after clopidogrel administration to determine plasma concentrations of clopidogrel active metabolite (CAM) and platelet function. Platelet aggregation was measured by light transmittance aggregometry (LTA) and platelet reactivity index by flow cytometric vasodilator-stimulated phosphoprotein (VASP) analysis. The areas under the curve and maximum plasma concentrations of CAM were, respectively, 20.6 and 25.3% lower after co-administration of fluoxetine compared with administration of clopidogrel alone. The percentage maximum platelet aggregation values in the presence of 5 μM and 10 μM adenosine diphosphate, measured by LTA, were, respectively, 13.9 and 22.4% lower after fluoxetine co-administration. The platelet reactivity index measured by the flow cytometric VASP method was 36.8% lower when clopidogrel was administered in conjunction with fluoxetine.
Collapse
Affiliation(s)
- Xavier Delavenne
- Laboratoire de Pharmacologie Toxicologie, CHU Saint-Etienne, F-42055, Saint-Etienne, France; Université de Lyon, F-42023, Saint-Etienne, France; Groupe de Recherche sur la Thrombose, EA3065, Université de Saint-Etienne, Jean Monnet, F-42023, Saint-Etienne, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Fontana P, James R, Barazer I, Berdagué P, Schved JF, Rebsamen M, Vuilleumier N, Reny JL. Relationship between paraoxonase-1 activity, its Q192R genetic variant and clopidogrel responsiveness in the ADRIE study. J Thromb Haemost 2011; 9:1664-6. [PMID: 21692977 DOI: 10.1111/j.1538-7836.2011.04409.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
|