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  4. Concomitant use of calcium channel blockers with dual antiplatelet therapy and re-hospitalization for acute coronary syndrome
 
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Concomitant use of calcium channel blockers with dual antiplatelet therapy and re-hospitalization for acute coronary syndrome

Journal
Pharmacoepidemiology and Drug Safety
Journal Volume
26
Journal Issue
3
Pages
229-238
Date Issued
2017
Author(s)
Wang C.-Y.
Lin Z.-F.
CHII-MING LEE  
Tsai Y.-W.
Huang T.-Y.
LI-JIUAN SHEN  
FEI-YUAN HSIAO  
DOI
10.1002/pds.4147
URI
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85008497333&doi=10.1002%2fpds.4147&partnerID=40&md5=0db0bec48bb753186f3e126e7843df8d
https://scholars.lib.ntu.edu.tw/handle/123456789/524388
Abstract
Background: Existing studies suggested that concomitant use of calcium channel blockers (CCBs) may interfere with the antiplatelet effect of clopidogrel. The objective of this study was to examine the effect of concomitant use of CCBs and clopidogrel on risks of acute coronary syndrome (ACS) re-hospitalization in patients receiving percutaneous coronary intervention. Methods: Using the Taiwan National Health Insurance Research Database, we identified 51 925 patients who were admitted for newly diagnosed ACS, received percutaneous coronary intervention, and used clopidogrel within 1 year after discharge. We further stratified them into three groups based on their uses of guideline-recommended secondary prevention medications for ACS (fully, partially, and non-compliant groups) to assess the potential modification effect of guideline compliance. For each group, we conducted a 1:1 propensity score matching to minimize selection bias. Cox proportional hazard models were used to investigate the effect of concomitant use of CCBs (overall, subclasses, and individual CCBs) and clopidogrel on risks of ACS re-hospitalization. Results: Concomitant use of CCBs in patients discharged with clopidogrel was significantly associated with a lower risk of ACS re-hospitalization in the fully compliant group (HRfully compliant = 0.82 [95% confidence interval 0.75–0.89], p < 0.001) but was associated with increased risk of ACS re-hospitalization in the non-compliant group (HRnon-compliant = 1.22 [1.03–1.45], p = 0.0252). Conclusions: Different guideline compliance of secondary prevention medications could modify the potential drug–drug interaction between clopidogrel and CCBs. Concomitant use of CCBs and clopidogrel was significantly associated with increased risk of ACS re-hospitalization in ACS patients not compliant to guideline-recommended secondary prevention drugs. Copyright ? 2017 John Wiley & Sons, Ltd. Copyright ? 2017 John Wiley & Sons, Ltd.
SDGs

[SDGs]SDG3

Other Subjects
amlodipine; calcium channel blocking agent; clopidogrel; felodipine; antithrombocytic agent; calcium channel blocking agent; clopidogrel; ticlopidine; acute coronary syndrome; adult; Article; dual antiplatelet therapy; female; hospital discharge; hospital readmission; human; major clinical study; male; middle aged; percutaneous coronary intervention; practice guideline; priority journal; propensity score; secondary prevention; selection bias; Taiwan; acute coronary syndrome; aged; analogs and derivatives; combination drug therapy; drug interaction; factual database; hospital readmission; pathophysiology; procedures; proportional hazards model; protocol compliance; statistics and numerical data; very elderly; Acute Coronary Syndrome; Aged; Aged, 80 and over; Calcium Channel Blockers; Databases, Factual; Drug Interactions; Drug Therapy, Combination; Female; Guideline Adherence; Humans; Male; Middle Aged; Patient Readmission; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Practice Guidelines as Topic; Proportional Hazards Models; Secondary Prevention; Taiwan; Ticlopidine
Publisher
John Wiley and Sons Ltd
Type
journal article

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