Document Detail


Effects of PPIs and an H2 blocker on the antiplatelet function of clopidogrel in Japanese patients under dual antiplatelet therapy.
MedLine Citation:
PMID:  22472213     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is essential after percutaneous coronary intervention (PCI). Clopidogrel is a prodrug and changed into active metabolite by cytochrome p450 enzymes (CYPs), especially CYP2C19. Proton pump inhibitors (PPIs) are used for the prevention of aspirin-induced gastrointestinal bleeding. PPIs are also metabolized by CYP2C19, although the degree of its contribution is dependent on the kind of PPI. Omeprazole, a PPI, has been reported to weaken the antiplatelet effects of clopidogrel. Famotidine, a histamine receptor type 2 (H2) blocker, could also be an alternative to PPIs. The aim of this study was to evaluate the effects of PPIs and an H2 blocker on the antiplatelet function of clopidogrel.
METHODS: Patients receiving DAPT due to prior PCI, who took either omeprazole or rabeprazole, were enrolled (n=25). The initial PPI was changed to the other PPI as a crossover study. In another study, patients undergoing DAPT without taking PPIs or H2 blockers were enrolled (n=30) and famotidine was added.
RESULTS: Platelet aggregability when taking omeprazole was higher than when taking rabeprazole, evaluated by an optical aggregometer using collagen as a stimulus (p=0.0051) and by the VerifyNow P2Y12 assay (p=0.0060). Platelet aggregability when taking rabeprazole was comparable to that in control patients (n=15). Concomitant use of famotidine had no effect.
CONCLUSION: Omeprazole significantly reduced the antiplatelet effect of clopidogrel and this effect on clopidogrel was stronger than that of rabeprazole. Concomitant use of famotidine had no effect on the antiplatelet effect of clopidogrel.
Authors:
Keiichiro Yamane; Yoshihiro Kato; Junichi Tazaki; Tomohisa Tada; Takeru Makiyama; Masao Imai; Toshikazu Jinnai; Tomoyuki Ikeda; Ryutaro Shirakawa; Takeshi Kimura; Hisanori Horiuchi
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-04-04
Journal Detail:
Title:  Journal of atherosclerosis and thrombosis     Volume:  19     ISSN:  1880-3873     ISO Abbreviation:  J. Atheroscler. Thromb.     Publication Date:  2012  
Date Detail:
Created Date:  2012-07-13     Completed Date:  2012-12-13     Revised Date:  2013-04-16    
Medline Journal Info:
Nlm Unique ID:  9506298     Medline TA:  J Atheroscler Thromb     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  559-69     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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MeSH Terms
Descriptor/Qualifier:
2-Pyridinylmethylsulfinylbenzimidazoles / therapeutic use
Aged
Asian Continental Ancestry Group
Aspirin / therapeutic use
Case-Control Studies
Coronary Artery Disease / drug therapy*
Cross-Over Studies
Drug Therapy, Combination
Enzyme Inhibitors / therapeutic use
Female
Histamine H2 Antagonists / therapeutic use*
Humans
Male
Omeprazole / therapeutic use
Platelet Aggregation / drug effects*
Platelet Aggregation Inhibitors / therapeutic use*
Prognosis
Prospective Studies
Proton Pump Inhibitors / therapeutic use*
Ticlopidine / analogs & derivatives*,  therapeutic use
Chemical
Reg. No./Substance:
0/2-Pyridinylmethylsulfinylbenzimidazoles; 0/Enzyme Inhibitors; 0/Histamine H2 Antagonists; 0/Platelet Aggregation Inhibitors; 0/Proton Pump Inhibitors; 32828355LL/rabeprazole; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 73590-58-6/Omeprazole; A74586SNO7/clopidogrel

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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