Concomitant use of calcium channel blockers with dual antiplatelet therapy and re-hospitalization for acute coronary syndrome

Chen-Yu Wang; Zhen-Fang Lin; Chii-Ming Lee; Yi-Wen Tsai; Ting-Ying Huang; Li-Jiuan Shen; Fei-Yuan Hsiao

doi:10.1002/pds.4147

Concomitant use of calcium channel blockers with dual antiplatelet therapy and re-hospitalization for acute coronary syndrome

Pharmacoepidemiol Drug Saf. 2017 Mar;26(3):229-238. doi: 10.1002/pds.4147. Epub 2017 Jan 9.

Authors

Chen-Yu Wang^{1

2}, Zhen-Fang Lin^{1

2

3}, Chii-Ming Lee⁴, Yi-Wen Tsai⁵, Ting-Ying Huang⁶, Li-Jiuan Shen^{1

2

3}, Fei-Yuan Hsiao^{1

2

3}

Affiliations

¹ Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
² School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁵ Institute of Health and Welfare, National Yang-Ming University, Taipei, Taiwan.
⁶ Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD, USA.

PMID: 28067454
DOI: 10.1002/pds.4147

Abstract

Background: Existing studies suggested that concomitant use of calcium channel blockers (CCBs) may interfere with the antiplatelet effect of clopidogrel. The objective of this study was to examine the effect of concomitant use of CCBs and clopidogrel on risks of acute coronary syndrome (ACS) re-hospitalization in patients receiving percutaneous coronary intervention.

Methods: Using the Taiwan National Health Insurance Research Database, we identified 51 925 patients who were admitted for newly diagnosed ACS, received percutaneous coronary intervention, and used clopidogrel within 1 year after discharge. We further stratified them into three groups based on their uses of guideline-recommended secondary prevention medications for ACS (fully, partially, and non-compliant groups) to assess the potential modification effect of guideline compliance. For each group, we conducted a 1:1 propensity score matching to minimize selection bias. Cox proportional hazard models were used to investigate the effect of concomitant use of CCBs (overall, subclasses, and individual CCBs) and clopidogrel on risks of ACS re-hospitalization.

Results: Concomitant use of CCBs in patients discharged with clopidogrel was significantly associated with a lower risk of ACS re-hospitalization in the fully compliant group (HR_{fully compliant} = 0.82 [95% confidence interval 0.75-0.89], p < 0.001) but was associated with increased risk of ACS re-hospitalization in the non-compliant group (HR_{non-compliant} = 1.22 [1.03-1.45], p = 0.0252).

Conclusions: Different guideline compliance of secondary prevention medications could modify the potential drug-drug interaction between clopidogrel and CCBs. Concomitant use of CCBs and clopidogrel was significantly associated with increased risk of ACS re-hospitalization in ACS patients not compliant to guideline-recommended secondary prevention drugs. Copyright © 2017 John Wiley & Sons, Ltd.

Keywords: acute coronary syndrome (ACS); calcium channel blockers (CCBs); clopidogrel; percutaneous coronary intervention (PCI); pharmacoepidemiology; re-hospitalization.

MeSH terms

Acute Coronary Syndrome / physiopathology
Acute Coronary Syndrome / therapy*
Aged
Aged, 80 and over
Calcium Channel Blockers / administration & dosage*
Clopidogrel
Databases, Factual
Drug Interactions
Drug Therapy, Combination
Female
Guideline Adherence
Humans
Male
Middle Aged
Patient Readmission / statistics & numerical data*
Percutaneous Coronary Intervention / methods
Platelet Aggregation Inhibitors / administration & dosage*
Practice Guidelines as Topic
Proportional Hazards Models
Secondary Prevention / methods
Taiwan
Ticlopidine / administration & dosage
Ticlopidine / analogs & derivatives

Substances

Calcium Channel Blockers
Platelet Aggregation Inhibitors
Clopidogrel
Ticlopidine