Controversia terapéutica: clopidogrel y estatinas

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.