Clinical importance of aspirin and clopidogrel resistance

Table 1 The role of clopidogrel and statin interaction based on recent clinical trials

Study	Sample size	Comparison	Primary end point	Comment
CREDO substudy[66]	1159	Post hoc analysis categorizing baseline statin use to those predominantly metabolized by CYP3A4 or not	1 yr composite endpoint of death, myocardial infarction and stroke	No detrimental effect
GRACE[67]	15 693	Four groups: group I received aspirin alone, group II aspirin and clopidogrel, group III aspirin and statin and group IV aspirin, clopidogrel and statin	6 mo mortality adjusted for baseline characteristics, in-hospital medications and procedures, re-hosp and revascularization	No detrimental effect
MITRA plus[68]	2086	Two groups: group I received atorvastatin and clopidogrel, group II other statins (both lipophilic and non-lipophilic) and clopidogrel	Long-term mortality	No detrimental effect
Mukherjee et al[69]	1651	Two groups: group I received CYP3A4 statin plus clopidogrel, group II received non-CYP3A4 statin plus clopidogrel	In-hospital and 6 mo mortality	No detrimental effect
Brophy et al[70]	2927	Two groups: group I received clopidogrel and atorvastatin, group II clopidogrel alone	30-d rates of adverse cardiovascular events (composite of death, myocardial infarction, unstable angina, stroke or transient ischaemic attack and repeat revascularization procedures)	Worse outcome associated with statins
CHARISMA substudy[71]	10 078	Post hoc analysis categorizing baseline statin use to those predominantly metabolized by CYP3A4 or not	Composite of myocardial infarction, stroke or cardiovascular death at median follow-up of 28 mo	No detrimental effect

Taken from Bhindi R, Ormerod O, Newton J, Banning AP, Testa L. Interaction between statins and clopidogrel: is there anything clinically relevant? QJM 2008; 101: 915-925[72].