Skip to main content
SpringerLink
Log in

St. John’s Wort in Patients Non-responders to Clopidogrel Undergoing Percutaneous Coronary Intervention: a Single-Center Randomized Open-Label Trial (St. John’s Trial)

  • Published:
Journal of Cardiovascular Translational Research Aims and scope Submit manuscript

Abstract

We assessed if St. John’s Wort (SJW) improves platelet response in patients (pts) resistant to clopidogrel after percutaneous coronary intervention (PCI). Stable angina pts non-responders to 600 mg clopidogrel (P2Y12 reaction units (PRU) >240) were randomized (2:1) to SJW (n = 15) or placebo (n = 8). SJW (300 mg × 3/day) was administrated for 2 weeks after PCI. Platelet reactivity was assessed by VerifyNowTM before (BL), 2 (T1), and 4 weeks (T2) after PCI. PRU significantly changed during protocol in SJW (BL (316 ± 60) vs. T1 (170 ± 87) vs. T2 (220 ± 96), p < 0.0001) and placebo group (BL (288 ± 36) vs. T1 (236 ± 31) vs. T2 (236 ± 62), p = 0.046). Yet, PRU changes from BL were higher at T1 in SJW than in placebo group (Δ%, −47 ± 24 vs. −16 ± 15, p = 0.0033), with no differences at T2 between the groups (Δ%, −30 ± 29 vs. −17 ± 24, p = 0.30). Residual platelet reactivity improved with SJW during the first month post-PCI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lau, C. W., Gurbel, P. A., Watkins, P. B., Neer, C. J., Hopp, A. S., Carville, D. G., et al. (2004). Contribution of cytochrome P450 3A4 metabolic activity to the phenomenon of clopidogrel resistance. Circulation, 109, 166–171.

    Article  PubMed  CAS  Google Scholar 

  2. Patti, G., Nusca, A., Mangiacapra, F., Gatto, L., D’Ambrosio, A., & Di Sciacio, G. (2008). Point-of-care measurement of clopidogrel responsiveness predicts clinical outcome in patients undergoing percutaneous coronary intervention. Journal of the American College of Cardiology, 52, 1128–1133.

    Article  PubMed  CAS  Google Scholar 

  3. Daemen, J., Wenaweser, P., Tsuchida, K., Abrecht, L., Vaina, S., Morger, C., et al. (2007). Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet, 369, 667–678.

    Article  PubMed  CAS  Google Scholar 

  4. Mangiacapra, F., De Bruyne, B., Muller, O., Trana, C., Ntalianis, A., Bartunek, J., et al. (2010). High residual platelet reactivity after clopidogrel: extent of coronary atherosclerosis and periprocedural myocardial infarction in patients with stable angina undergoing percutaneous coronary intervention. Journal of the American College of Cardiology Interventions, 3, 35–40.

    Google Scholar 

  5. Roby, C. A., Anderson, G. D., Kantor, E., Dryer, D. A., & Burstein, A. H. (2000). St. John’s Wort: effect on CYP3A4 activity. Clinical Pharmacology and Therapeutics, 67, 451–457.

    Article  PubMed  CAS  Google Scholar 

  6. Lau, W. C., Welch, T. D., Shields, T., Rubenfire, M., Tantry, U. S., & Gurbel, P. A. (2011). The effect of St John’s Wort on the pharmacodynamic response of clopidogrel in hyporesponsive volunteers and patients: increased platelet inhibition by enhancement of CYP3A4 metabolic activity. Journal of Cardiovascular Pharmacology, 57, 86–93.

    Article  PubMed  CAS  Google Scholar 

  7. Barbato, E., Piscione, F., Bartunek, J., Galasso, G., Cirillo, P., De Luca, G., et al. (2005). Role of beta2 adrenergic receptors in human atherosclerotic coronary arteries. Circulation, 111, 288–294.

    Article  PubMed  CAS  Google Scholar 

  8. Mangiacapra, F., Bartunek, J., Bijnens, N., Peace, A. J., Dierickx, K., Bailleul, E., et al. (2012). Peri-procedural variations of platelet reactivity during elective percutaneous coronary intervention. Journal of Thrombosis and Haemostasis, 10, 2452–2461.

    Article  PubMed  CAS  Google Scholar 

  9. Campo, G., Parrinello, G., Ferraresi, P., Lunghi, B., Tebaldi, M., Miccoli, M., et al. (2011). Prospective evaluation of on-clopidogrel platelet reactivity over time in patients treated with percutaneous coronary intervention relationship with gene polymorphisms and clinical outcome. Journal of the American College of Cardiology, 57, 2474–2483.

    Article  PubMed  CAS  Google Scholar 

  10. Collet, J. P., Silvain, J., Landivier, A., Tanguy, M. L., Cayla, G., Bellemain, A., et al. (2008). Dose effect of clopidogrel reloading in patients already on 75-mg maintenance dose: the reload with clopidogrel before coronary angioplasty in subjects treated long term with dual antiplatelet therapy (RELOAD) study. Circulation, 118, 1225–1233.

    Article  PubMed  CAS  Google Scholar 

  11. Wiviott, S. D., Braunwald, E., McCabe, C. H., Montalescot, G., Ruzyllo, W., Gottlieb, S., et al. (2007). Prasugrel versus clopidogrel in patients with acute coronary syndromes. New England Journal of Medicine, 357, 2001–2015.

    Article  PubMed  CAS  Google Scholar 

  12. Wallentin, L., Becker, R. C., Budaj, A., Cannon, C. P., Emanuelsson, H., Held, C., et al. (2009). Ticagrelor versus clopidogrel in patients with acute coronary syndromes. New England Journal of Medicine, 361, 1045–1057.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiovascular Center Aalst OLV Clinic, Moorselbaan, 164, 9300, Aalst, Belgium

    Catalina Trana, Gabor Toth, William Wijns & Emanuele Barbato

Authors
  1. Catalina Trana
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gabor Toth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William Wijns
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emanuele Barbato
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emanuele Barbato.

Additional information

Catalina Trana and Gabor Toth contributed equally to this study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Trana, C., Toth, G., Wijns, W. et al. St. John’s Wort in Patients Non-responders to Clopidogrel Undergoing Percutaneous Coronary Intervention: a Single-Center Randomized Open-Label Trial (St. John’s Trial). J. of Cardiovasc. Trans. Res. 6, 411–414 (2013). https://doi.org/10.1007/s12265-013-9455-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12265-013-9455-2

Keywords

Search

Navigation