Case: 44 years old male was discharged 12 weeks ago on Dual Anti-Platelet Therapy (DAPT) from the hospital after acquiring a coronary stent due to an acute myocardial infarction. The patient presented to the ER with chest pain and an EKG similar to the previous presentation, with high suspicion of stent thrombosis. Patient reports 100% compliance with medications. The patient was recently started on Calcium channel blockers (CCBs) as an outpatient due to still uncontrolled hypertension (HTN).
Discussion: Although clinically insignificant in most cases, CCBs may decrease the efficacy of clopidogrel because they inhibit CYP3A4. Still, it is very kosher to prescribe CCBs to patients on DAPT therapy due to the lack of concrete evidence and conflicting studies.
An astute clinician should consider this possibility, as stent thrombosis can prove fatal.
#pharmacology
#cardiology
References:
1. Gremmel T, Steiner S, Seidinger D, et al. Calcium-channel blockers decrease clopidogrel-mediated platelet inhibition. Heart 2010; 96:186.
2. Siller-Matula JM, Lang I, Christ G, Jilma B. Calcium-channel blockers reduce the antiplatelet effect of clopidogrel. J Am Coll Cardiol 2008; 52:1557.
3. Olesen JB, Gislason GH, Charlot MG, et al. Calcium-channel blockers do not alter the clinical efficacy of clopidogrel after myocardial infarction: a nationwide cohort study. J Am Coll Cardiol 2011; 57:409.
4. Good CW, Steinhubl SR, Brennan DM, et al. Is there a clinically significant interaction between calcium channel antagonists and clopidogrel?: results from the Clopidogrel for the Reduction of Events During Observation (CREDO) trial. Circ Cardiovasc Interv 2012; 5:77.
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