Clopidogrel bioactivation and risk of bleeding in patients cotreated with angiotensin-converting enzyme inhibitors after myocardial infarction: a proof-of-concept study
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Clopidogrel bioactivation and risk of bleeding in patients cotreated with angiotensin-converting enzyme inhibitors after myocardial infarction : a proof-of-concept study. / Kristensen, K E; Zhu, H-J; Wang, X; Gislason, G H; Torp-Pedersen, C; Rasmussen, H B; Markowitz, J S; Hansen, Peter Riis.
In: Clinical Pharmacology and Therapeutics, Vol. 96, No. 6, 12.2014, p. 713-722.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Clopidogrel bioactivation and risk of bleeding in patients cotreated with angiotensin-converting enzyme inhibitors after myocardial infarction
T2 - a proof-of-concept study
AU - Kristensen, K E
AU - Zhu, H-J
AU - Wang, X
AU - Gislason, G H
AU - Torp-Pedersen, C
AU - Rasmussen, H B
AU - Markowitz, J S
AU - Hansen, Peter Riis
PY - 2014/12
Y1 - 2014/12
N2 - Clopidogrel is an oral antiplatelet prodrug, the majority of which is hydrolyzed to an inactive metabolite by hepatic carboxylesterase 1 (CES1). Most angiotensin-converting enzyme inhibitors (ACEIs) are also metabolized by this enzyme. We examined the effects of ACEIs on clopidogrel bioactivation in vitro and linked the results with a pharmacoepidemiological study. In vitro, ACEIs inhibited CES1-mediated hydrolysis of a model substrate, and trandolapril and enalapril increased formation of clopidogrel active metabolite. In 70,934 patients with myocardial infarction, hazard ratios for clinically significant bleeding in ACEI-treated patients cotreated with or without clopidogrel were 1.10 (95% confidence interval (CI): 0.97-1.25, P = 0.124) and 0.90 (95% CI: 0.81-0.99, P = 0.025), respectively, as compared with patients who did not receive ACEIs. This difference was statistically significant (P = 0.002). We conclude that cotreatment with selected ACEIs and clopidogrel may increase the risk of bleeding. Combination of in vitro and pharmacoepidemiological studies may be a useful paradigm for assessment of drug-drug interactions.
AB - Clopidogrel is an oral antiplatelet prodrug, the majority of which is hydrolyzed to an inactive metabolite by hepatic carboxylesterase 1 (CES1). Most angiotensin-converting enzyme inhibitors (ACEIs) are also metabolized by this enzyme. We examined the effects of ACEIs on clopidogrel bioactivation in vitro and linked the results with a pharmacoepidemiological study. In vitro, ACEIs inhibited CES1-mediated hydrolysis of a model substrate, and trandolapril and enalapril increased formation of clopidogrel active metabolite. In 70,934 patients with myocardial infarction, hazard ratios for clinically significant bleeding in ACEI-treated patients cotreated with or without clopidogrel were 1.10 (95% confidence interval (CI): 0.97-1.25, P = 0.124) and 0.90 (95% CI: 0.81-0.99, P = 0.025), respectively, as compared with patients who did not receive ACEIs. This difference was statistically significant (P = 0.002). We conclude that cotreatment with selected ACEIs and clopidogrel may increase the risk of bleeding. Combination of in vitro and pharmacoepidemiological studies may be a useful paradigm for assessment of drug-drug interactions.
KW - Aged
KW - Angiotensin-Converting Enzyme Inhibitors
KW - Biotransformation
KW - Carboxylic Ester Hydrolases
KW - Drug Interactions
KW - Female
KW - Hemorrhage
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction
KW - Platelet Aggregation Inhibitors
KW - Risk
KW - Ticlopidine
U2 - 10.1038/clpt.2014.183
DO - 10.1038/clpt.2014.183
M3 - Journal article
C2 - 25222620
VL - 96
SP - 713
EP - 722
JO - Clinical Pharmacology and Therapeutics
JF - Clinical Pharmacology and Therapeutics
SN - 0009-9236
IS - 6
ER -
ID: 137740707