Effect of Amlodipine on Anti-platelet Drug Effect in Patients With Coronary Artery Disease

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

97 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-07-31

Study Completion Date

2011-04-30

Brief Summary

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Clopidogrel can reduce risk of cardiovascular disease by inhibiting platelet aggregation. It is metabolized to an active drug by a liver enzyme. Its efficacy may be measured by blood sampling for platelet activity, analyzed by VerifyNow device. Calcium Channel blocker (CCB) is also commonly used for blood pressure and anginal control in these patients. Dihydropyridine group of calcium channel blocker (e.g. amlodipine) inhibits this enzyme. There are observational studies reporting dihydropyridine CCB reducing clopidogrel effect, but the clinical implication is unclear.

This study test the hypothesis that there is no significant effect of dihydropyridines CCB on clopidogrel response compared with control. After giving consent, patients with suboptimal blood pressure or anginal control will be randomized to receive either dihydropyridine CCB or non-CCB as placebo. These patient will be follow-up in 1 month.

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Detailed Description

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Clopidogrel is a pro-drug, which requires hepatic transformation by the cytochrome P450 isoform 3A4 to generate the active metabolite. It inhibits adenosine-5-diphosphate (ADP)-induced platelet aggregation by irreversibly blocking the platelet P2Y12 receptor. However, response to clopidogrel shows wide individual variability, and patients with high on-treatment residual ADP-induced platelet reactivity are at an increased risk of adverse cardiovascular events. Previous study suggest co-administration of CCBs is associated with decreased platelet inhibition by clopidogrel, but these observational studies are confounded by patient's characteristics baseline difference such as proportion of hypertension and diabetes.

The objective of this randomized controlled study is to compare amlodipine with placebo on anti-platelet effect of clopidogrel.

Conditions

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Ischemic Heart Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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non-amlodipine

For patient with suboptimal angina control: anti-anginal agent excluding calcium channel blocker

Group Type ACTIVE_COMPARATOR

Amlodipine

Intervention Type DRUG

For patient with suboptimal angina control: oral 2.5-10mg daily

non - amlodipine

For patient with suboptimal BP control: anti-hypertensive agent excluding calcium channel blocker

Group Type ACTIVE_COMPARATOR

Amlodipine

Intervention Type DRUG

For patient with suboptimal BP control: 2.5-10mg daily po

Interventions

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Amlodipine

For patient with suboptimal angina control: oral 2.5-10mg daily

Intervention Type DRUG

Amlodipine

For patient with suboptimal BP control: 2.5-10mg daily po

Intervention Type DRUG

Other Intervention Names

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Norvasc Norvasc

Eligibility Criteria

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Inclusion Criteria

* ischemic heart disease patient, and
* given loading or maintenance dose of clopidogrel and in need of it for 1 or more month
* and in need of additional drug for optimal BP control (aim blood pressure \<130/90) or angina control.

Exclusion Criteria

* existing use of amlodipine
* thrombocytopenia
* end stage renal failure
* allergy to clopidogrel/ amlodipine
* pregnancy/ lactation
* strong inhibitor or inducer of cytochrome P450 3A4 enzyme within 7 days before start of the study.

Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No