Comparative effect of clopidogrel plus aspirin and aspirin monotherapy on hematological parameters using propensity
Masatoshi Hayasaka1, Yasuo Takahashi, Yayoi Nishida
1Department of Pharmacy, Nihon University Itabashi Hospital, Tokyo, Japan.
Insights
Combination therapy with clopidogrel and aspirin may lead to greater adverse hematological effects compared to aspirin monotherapy. This study evaluated laboratory parameters in real-world clinical settings.
Area of Science:
- Cardiology
- Pharmacology
- Hematology
Background:
- Clopidogrel and aspirin are crucial antiplatelet agents for preventing recurrent stroke and cardiovascular events.
- Dual antiplatelet therapy (DAPT) increases hemorrhage risk, but its impact on laboratory parameters requires further real-world investigation.
- This study addresses the need to understand DAPT's effects on laboratory markers in clinical practice.
Purpose of the Study:
- To compare the effects of clopidogrel plus aspirin combination therapy versus aspirin monotherapy on key laboratory parameters.
- To evaluate changes in serum creatinine, liver enzymes, and hematological indices.
- To assess these effects in a real-world clinical setting.
Main Methods:
- Retrospective analysis of 260 new drug users (130 DAPT, 130 aspirin monotherapy) from November 2004 to May 2011.
- Propensity score matching was used to create comparable cohorts.
- Multivariate regression analyzed serum creatinine, AST, ALT, hemoglobin, hematocrit, and cell counts up to two months post-initiation.
Main Results:
- No significant baseline differences were observed between the two groups.
- Users of clopidogrel plus aspirin showed significantly greater reductions in white blood cell and red blood cell counts.
- Hemoglobin levels and hematocrit also demonstrated significantly larger decreases in the DAPT group.
Conclusions:
- Combination therapy with clopidogrel and aspirin may be associated with more pronounced adverse hematological effects than aspirin monotherapy.
- These findings highlight the importance of monitoring hematological parameters in patients receiving DAPT.
- Further research is warranted to elucidate the clinical implications of these observed hematological changes.
Background:
Clopidogrel and aspirin are antiplatelet agents that are recommended to reduce the risk of recurrent stroke and other cardiovascular events. Dual antiplatelet therapy with clopidogrel and aspirin has been shown to increase the risk of hemorrhage, but the effects of the drugs on laboratory parameters have not been well studied in real-world clinical settings. Therefore, we evaluated and compared the effects of combination therapy with clopidogrel plus aspirin and aspirin monotherapy on laboratory parameters.
Methods:
We used data from the Nihon University School of Medicine Clinical Data Warehouse obtained between November 2004 and May 2011 to identify cohorts of new users (n = 130) of clopidogrel (75 mg/day) plus aspirin (100 mg/day) and a propensity score matched sample of new users (n = 130) of aspirin alone (100 mg/day). We used a multivariate regression model to compare serum levels of creatinine, aspartate aminotransferase, and alanine aminotransferase, as well as hematological parameters including hemoglobin level, hematocrit, and white blood cell, red blood cell, and platelet counts up to 2 months after the start of administration of the study drugs.
Results:
There were no significant differences for any characteristics and baseline laboratory parameters between users of clopidogrel plus aspirin and users of aspirin alone. Reductions in white blood cell and red blood cell counts, hemoglobin levels, and hematocrit in users of clopidogrel plus aspirin were significantly greater than those in users of aspirin alone.
Conclusion:
Our findings suggest that adverse hematological effects may be greater with combination clopidogrel plus aspirin therapy than with aspirin monotherapy.
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:29Pharmacogenetic Phenotypes: Alterations in Pharmacokinetics, Drug Targets and Biologic Milieu