Does the use of high dose atorvastatin in combination with dual antiplatelet therapy modify residual platelet activity in patients with acute coronary syndrome?

    Authors

    Keywords

    platelet reactivity, acute coronary syndrome, P2Y12 inhibitors, statins

    DOI

    https://doi.org/10.15836/ccar2019.213

    Full Text

    Introduction : Dual antiplatelet therapy (DAPT) represents one of the pillars in the treatment of acute coronary syndromes (ACS) ( 1 ). In the past the most commonly used combination of antiplatelet drugs has been acetylsalicylic acid (ASA) and clopidogrel. Clopidogrel had a high incidence rate of high residual platelet reactivity and has, in recent years, been replaced with ticagrelor, a more potent platelet inhibitor with a more uniformed response across the patient population. The effect of high dose atorvastatin on platelet reactivity mediated by ASA and clopidogrel is well researched, however no studies have been published analyzing this effect when clopidogrel is substituted with ticagrelor. Purpose: To investigate if high dose atorvastatin modifies PF mediated by DAPT in patient with ACS as measured by platelet function tests (PFTs). Patients and Methods : We analyzed clinical characteristics and PF in patients presenting with ACS at the Department of Cardiovascular Diseases at the University Hospital Centre Zagreb from December 2015 to February 2018. Primary endpoint was PF after treatment with DAPT and/or high dose atorvastatin. We analyzed PF using the Multiplate platelet function analyzer. PFTs were performed 18-24 hours after therapy initiation. None of the patients were taking statins before the index event. Results : There were 35 patients with a mean (SD) age of 61.6 (12.2) years in the atorvastatin group and 29 patients with a mean (SD) of 62.6 (9.6) years in the no-atorvastatin group. Both groups were identical in all the baseline parameters except history of hyperlipidemia (34.5% vs 65.7%, P=0.023). There were no significant differences between the two groups in PF analyzed with PFTs ( Figure 1 ). The difference in residual platelet reactivity remained non-significant even after adjusting for sex, age and hyperlipidemia as the only co-variate that was significantly different between the group (P=0.432). Platelet reactivity with and without high dose atorvastatin. NS = non-significant. Conclusion : In this pilot study on a limited sample we found no difference in residual PF in patients on DAPT weather they are on treatment with high dose atorvastatin or not. These results show that the pleiotropic effects of atorvastatin on platelet reactivity are not significant in patients taking DAPT with ticagrelor and ASA.

    Cardiologia Croatica
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    Does the use of high dose atorvastatin in combination with dual antiplatelet therapy modify residual platelet activity in patients with acute coronary syndrome?

    Extended Abstract
    Issue9-10
    Published
    Pages213
    PDF via DOIhttps://doi.org/10.15836/ccar2019.213
    platelet reactivity
    acute coronary syndrome
    P2Y12 inhibitors
    statins

    Authors

    Saša Pavasović*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Dubravka ŠipušUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Jure SamardžićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Hrvoje JurinORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Marijan PašalićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Boško SkorićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Maja ČikešORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Danijel LovrićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Jana Ljubas MačekORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Ivo PlanincORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor MiličićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    Full Text

    Introduction : Dual antiplatelet therapy (DAPT) represents one of the pillars in the treatment of acute coronary syndromes (ACS) ( 1 ). In the past the most commonly used combination of antiplatelet drugs has been acetylsalicylic acid (ASA) and clopidogrel. Clopidogrel had a high incidence rate of high residual platelet reactivity and has, in recent years, been replaced with ticagrelor, a more potent platelet inhibitor with a more uniformed response across the patient population. The effect of high dose atorvastatin on platelet reactivity mediated by ASA and clopidogrel is well researched, however no studies have been published analyzing this effect when clopidogrel is substituted with ticagrelor. Purpose: To investigate if high dose atorvastatin modifies PF mediated by DAPT in patient with ACS as measured by platelet function tests (PFTs). Patients and Methods : We analyzed clinical characteristics and PF in patients presenting with ACS at the Department of Cardiovascular Diseases at the University Hospital Centre Zagreb from December 2015 to February 2018. Primary endpoint was PF after treatment with DAPT and/or high dose atorvastatin. We analyzed PF using the Multiplate platelet function analyzer. PFTs were performed 18-24 hours after therapy initiation. None of the patients were taking statins before the index event. Results : There were 35 patients with a mean (SD) age of 61.6 (12.2) years in the atorvastatin group and 29 patients with a mean (SD) of 62.6 (9.6) years in the no-atorvastatin group. Both groups were identical in all the baseline parameters except history of hyperlipidemia (34.5% vs 65.7%, P=0.023). There were no significant differences between the two groups in PF analyzed with PFTs ( Figure 1 ). The difference in residual platelet reactivity remained non-significant even after adjusting for sex, age and hyperlipidemia as the only co-variate that was significantly different between the group (P=0.432). Platelet reactivity with and without high dose atorvastatin. NS = non-significant. Conclusion : In this pilot study on a limited sample we found no difference in residual PF in patients on DAPT weather they are on treatment with high dose atorvastatin or not. These results show that the pleiotropic effects of atorvastatin on platelet reactivity are not significant in patients taking DAPT with ticagrelor and ASA.