Información del artículo
El mecanismo patogénico común de los episodios isquémicos arteriales es la formación de un trombo sobre una placa aterosclerosa preexistente. En los pacientes con un episodio isquémico, la utilización de fármacos antiagregantes previene la aparición de nuevos episodios. En estos pacientes es frecuente la toma de estatinas para disminuir la colesterolemia. Descripciones iniciales indicaban que la administración de atorvastatina junto con clopidogrel podía hacer perder el efecto antiagregante de éste. La base molecular de la interacción clopidogrel y atorvastatina es que ambos son metabolizados por la misma isoenzima del citocromo P450, la 3A4. Este mismo efecto debería ocurrir con simvastatina y lovastatina, que también se metabolizan por 3A4. A partir de estos datos se hace una revisión de los trabajos publicados. Entre los 12 estudios de laboratorio hay 4 en los que hubo interacción y 8 en los que no. Entre los 4 estudios con objetivos clínicos ninguno demostró una interacción clínicamente significativa. La divergencia en los resultados se debe a la heterogeneidad en el diseño y la metodología. La conclusión es que, actualmente, no hay ninguna evidencia clínica que indique tener que limitar el uso de atorvastatina, simvastatina y lovastatina en pacientes que requieran la comedicación con clopidogrel.
Palabras clave:
Aterotrombosis
Antiagregantes
Prevención secundaria
Clopidogrel
Atorvastatina
Estatinas
Interacción farmacológica
The common pathogenic mechanism of ischemic episodes is the formation of a thrombus on a preexisting atherosclerotic plaque. In patients with an ischemic episode the use of antiaggregants prevents the development of further episodes. These patients are frequently prescribed statins to reduce cholesterolemia. Initial descriptions suggest that administration of atorvastatin together with clopidogrel could lead to the loss of atorvastatin's antiaggregant effect. The molecular basis of the interaction between clopidrogrel and atorvastatin is that both drugs are metabolized by the same cytochrome P450 isoenzyme, 3A4. The same effect should occur with simvastatin and lovastatin, which are also metabolized by 3A4. Based on these data, we reviewed the published studies. Of 12 laboratory studies, 4 reported this interaction and 8 did not. Of the 4 studies with clinical objectives, none showed a clinically significant interaction. The discrepancy in the results is due to differences in the design and methodology of these studies. In conclusion, currently there is no clinical evidence to suggest that the use of atorvastatin, simvastatin and lovastatin should be limited in patients requiring comedication with clopidogrel.
Key words:
Atherothrombosis
Antiaggregants
Secondary prevention
Clopidogrel
Atorvastatin
Statins
Pharmacological interaction
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