Key result
Pitavastatin did not affect clopidogrel response, whereas atorvastatin increased platelet reactivity in patients with coronary artery disease on dual antiplatelet therapy.
Why the study?
Does pitavastatin compared to atorvastatin improve platelet reactivity in patients with coronary artery disease treated with dual antiplatelet therapy?
RCT (n=155)
1:1
Does pitavastatin compared to atorvastatin improve platelet reactivity in patients with coronary artery disease treated with dual antiplatelet therapy?
In CAD patients on dual antiplatelet therapy, pitavastatin (a non-CYP3A4-metabolized statin) does not attenuate clopidogrel's antiplatelet effect, unlike atorvastatin, which significantly increases platelet reactivity in poor responders.
Answers are grounded in this paper and cite their sources.
May favor pitavastatin over atorvastatin in CAD patients on DAPT; extends RCT evidence on differential statin-clopidogrel interactions.
BACKGROUND: Levels of platelet reactivity in patients on dual antiplatelet therapy (DAPT) can be influenced by concomitant treatment with statins. We verified if the pharmacodynamic effects of CYP3A4-metabolized statins (atorvastatin) and non-CYP3A4-metabolized statins (pitavastatin) differ in patients with coronary artery disease (CAD) treated with DAPT. METHODS AND RESULTS: A total of 155 CAD patients receiving DAPT (clopidogrel 75mg plus aspirin 100mg) entered the PORTO trial. Patients were randomly assigned to atorvastatin (20mg day) or pitavastatin (4mg day) for 30 days, and then switched to the other drug for 30 days. Platelet reactivity was expressed as VerifyNow P2Y12 platelet response units (PRU) before and after each 30-day treatment period. High platelet reactivity was defined as PRU >208. As compared with pretreatment (192±49), PRU was significantly higher after 30-day atorvastatin (210±56; P=0.003), but was unchanged after 30-day pitavastatin (199±47 PRU, NS). In the 48 patients with PRU >208 at baseline (232±44), PRU increased significantly after 30-day atorvastatin (258±41, P=0.004), but not after 30-day pitavastatin (237±43, NS). In the 107 patients with PRU <208 at baseline (174±52), PRU did not change significantly with respect to baseline either after 30-day atorvastatin (188±61, NS) or after 30-day pitavastatin (181±59, NS). CONCLUSIONS: Pitavastatin, a non-CYP3A4-metabolized statin, does not affect clopidogrel's response as compared with atorvastatin in patients who are borderline or poor responders to DAPT.
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Pelliccia et al. (2013) conducted an RCT in Coronary artery disease (n=155). Pitavastatin vs. Atorvastatin (20 mg/day) was evaluated on Change in P2Y12 reaction units (PRU) as compared with baseline values after each 30-day treatment period (p=0.003). Pitavastatin did not affect clopidogrel response, whereas atorvastatin increased platelet reactivity in patients with coronary artery disease on dual antiplatelet therapy.
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