Author + information
- Zhengang Zhao,
- Mao Chen,
- Dejia Huang,
- Yong Peng,
- Hua Chai,
- Wei Liu,
- Qiao Li,
- Xin Ren,
- Xueqin Wang,
- Xiaolin Luo and
- Chen Zhang
Previous findings regarding the relationship between smoking and clopidogrel effects were considerably discrepant. This study sought to systematically review the medical literature to evaluate the role of smoking in clinical and pharmacodynamic response to clopidogrel.
Medline, EMBASE, and the Cochrane Library through August 2012 were searched. Reference lists and major conference abstracts were reviewed. Clinical as well as laboratory studies, which reported major adverse cardiovascular events (MACE, defined as a composite of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke) and on–clopidogrel platelet reactivity (OPR) according to smoking status respectively, were selected. Both full–text articles and abstracts were considered. Data were extracted from 7 clinical studies and 13 laboratory studies. Among which, 5 clinical studies and 12 laboratory studies, involving 49,443 and 6,799 patients respectively, were pooled separately under the random–effects model.
In 71.4% (5 of 7) clinical studies, clopidogrel was found to significantly reduce the risk for MACE only in current smokers. Pooled results revealed that the risk for MACE in current smokers was significantly reduced by clopidogrel treatment relative to aspirin or placebo (hazard ratio [HR]: 0.70; 95% confidence interval [CI]: 0.58 to 0.85), whereas no significant reduction in the risk was observed in non–current smokers (HR: 0.93; 95% CI: 0.87 to 1.00). As for the 13 laboratory studies, 8 (61.5%) reported significantly enhanced pharmacodynamic effects of clopidogrel in current smokes versus non–current smokers. Pooled standardized mean difference (SMD) revealed that current smokers had significantly lower OPR than non–current smokers (SMD: −0.30; 95% CI, −0.46 to −0.15).
Smoking appears to positively modify the relative clinical efficacy and pharmacodynamic effects of clopidogrel. The interindividual variability in response to clopidogrel particularly that associated with smoking deserves further attention.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Adjunct Pharmacology
Abstract Category: 39. TCT@ACC–i2: Adjunct Pharmacology
Presentation Number: 2115–225
- 2013 American College of Cardiology Foundation