J Thorac Cardiovasc Surg 2005;129:475-476
© 2005 The American Association for Thoracic Surgery
Reply to the Editor:
Papworth Hospital, Cambridge, United Kingdom
The opinion on the interaction between statins and clopidogrel is still subject to fierce debate.1,2 However, excluding subjects from the analysis because they are on statins effectively excludes the majority of patients undergoing coronary surgery. We report that clopidogrel, unlike aspirin, did not inhibit platelet aggregation in the first 5 postoperative days, a result that is applicable to the wider population of patients irrespective of the eventual outcome of the drug interaction debate.
Little consideration has been given to the suggestion of excluding nonresponders and low responders from the analysis. If we did that for any arm of any trial only the favorable responders would be left, giving the false impression of treatment efficacy. It is plausible that increasing the dose of clopidogrel may increase antiplatelet effects in similar conditions (but this should not be assumed). However, the current recommended dose is 75 mg per day, and a loading dose of clopidogrel is only indicated in unstable angina (300 mg single loading dose).3 This information is consistent with the product information sheet issued by Sanofi-Synthelabo (New York, NY).
Our aim was to report the results of an intention-to-treat randomized clinical trial, using approved drug doses, with findings that can be generalized to the wide population undergoing coronary surgery, not to manipulate analyses to favor any particular arm.
- Saw J, Steinhubl SR, Berger PB, Kereiakes DJ, Serebruany VL, Brennan D, et al. Lack of adverse clopidogrel-atorvastatin clinical interaction from secondary analysis of a randomized, placebo-controlled clopidogrel trial. Circulation. 2003;108:921-924.[Abstract/Free Full Text]
- Mitsios JV, Papathanasiou AI, Rodis FI, Elisaf M, Goudevenos JA, Tselepis AD. Atorvastatin does not affect the antiplatelet potency of clopidogrel when it is administered concomitantly for 5 weeks in patients with acute coronary syndromes. Circulation. 2004;109:1335-1338.[Abstract/Free Full Text]
- British National Formulary. London: British Medical Association and the Royal Pharmaceutical Society of Great Britain; 2003..