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Clopidogrel, an inactive thienopyridine prodrug, is converted in the liver to an active metabolite that inhibits platelet aggregation. These researchers prospectively investigated whether use of atorvastatin, which is metabolized by the cytochrome P450 3A4 enzyme (CYP3A4) in the liver, would inhibit clopidogrel activation.
Forty-four patients undergoing elective stent implantation and 27 volunteers took clopidogrel. Of the 44 patients, 16 were not taking statins, 9 were taking pravastatin (40 mg/day), and 19 were taking atorvastatin (10, 20, or 40 mg/day); of the 27 volunteers, 9 were given erythromycin (a CYP3A4 inhibitor), 10 rifampin (a CYP3A4 inducer), and 8 troleandomycin (a CYP3A4 inhibitor). At various time points over 30 days, platel…