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Impact of proton pump inhibitors on the antiplatelet effects of clopidogrel

埃索美拉唑 氯吡格雷 奥美拉唑 泮托拉唑 医学 质子抑制剂泵 血小板 阿司匹林 内科学 急性冠脉综合征 药理学 人口 胃肠病学 心肌梗塞 环境卫生
作者
Dirk Sibbing,Tanja Morath,Julia Stegherr,Siegmund Braun,Wolfgang Vogt,Martin Hadamitzky,Albert Schömig,Adnan Kastrati,Nicolas von Beckerath
出处
期刊:Thrombosis and Haemostasis [Thieme Medical Publishers (Germany)]
卷期号:101 (04): 714-719 被引量:396
标识
DOI:10.1160/th08-12-0808
摘要

Summary Patients receiving dual antiplatelet treatment with aspirin and clopidogrel are commonly treated with proton pump inhibitors (PPIs). Attenuating effects on platelet response to clopidogrel have been reported solely for the PPI omeprazole. PPIs differ in their metabolisation properties as well as their potential for drug-drug interactions. The aim of this study was to investigate the impact of different PPIs (pantoprazole, omeprazole, esomeprazole) on platelet response to clopidogrel in patients with previous coronary stent placement under chronic clopidogrel treatment. In a cross-sectional observational study, consecutive patients under clopidogrel maintenance treatment (n=1,000) scheduled for a control coronary angiography were enrolled. Adenosine diphosphate (ADP)-induced platelet aggregation (in AU*min) was measured with multiple electrode platelet aggregometry (MEA). From the entire study population, 268 (26.8%) patients were under PPI treatment at the time point of platelet function testing (pantoprazole, n=162; omeprazole, n=64; esomeprazole, n=42). Platelet aggregation (median [interquar-tile range]) was significantly higher in patients with omeprazole treatment (295.5 [193.5–571.2] AU*min) compared to patients without PPI treatment (220.0 [143.8–388.8] AU*min; p=0.001). Platelet aggregation was similar in patients with pantoprazole (226.0 [150.0–401.5] AU*min) or esomeprazole (209.0 [134.8–384.8] AU*min) treatment compared to patients without PPI treatment (p=0.69 and p=0.88, respectively). Attenuating effects of concomitant PPI treatment on platelet response to clopidogrel were restricted to the use of omeprazole. No attenuating effects on platelet response to clopidogrel were observed for pantoprazole or esomeprazole. Specifically designed and randomized clinical studies are needed to define the impact of concomitant PPI treatment on adverse events after percutaneous coronary intervention.

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