Document Detail


Pantoprazole does not influence the antiplatelet effect of clopidogrel-a whole blood aggregometry study after coronary stenting.
MedLine Citation:
PMID:  20410834     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Recent attention has been drawn to a potential drug-drug interaction observed between clopidogrel and proton pump inhibitors (PPIs). However, this potential interaction may not be a class effect of PPIs. We investigated if pantoprazole, which has a different metabolism than omeprazole, diminishes the effectiveness of clopidogrel. Our study included 336 patients (mean age 64.6 years; 106 women) 48 hours after percutaneous coronary stent implantation with a loading dose of 600 mg clopidogrel hydrogensulfate and 500 mg aspirin, followed by 75 mg clopidogrel and 100 mg aspirin daily. Whereas 188 patients (59 women) were not given any PPI comedication, 122 patients received pantoprazole and 26 either omeprazole or esomeprazole. The platelet aggregation followed by impedance aggregometry (in Ohm) was induced by 5 mmol/L adenosine diphosphate. The percentage of clopidogrel low-response (CLR) was similar between the non-PPI group [2.75 Ohm (confidence interval, CI: 2.25-3.26); 21.9% CLR] and the pantoprazole group [2.33 Ohm (CI: 1.79-2.87); 16.4% CLR] but higher in patients treated with omeprazole/esomeprazole (3.00 Ohm (CI: 1.49-4.51); 30.8% CLR). Multivariate regression analysis reveals that the risk of CLR in the pantoprazole comedication group was not increased compared with the group without any PPI [odds ratio 0.59 (CI: 0.31-1.13) 0.11]. Our data suggest that pantoprazole does not diminish the antiplatelet effectiveness of clopidogrel early after coronary stenting. Therefore, the use of pantoprazole seems preferable in patients treated with clopidogrel when a concomitant medication with a PPI is indicated.
Authors:
Horst Neubauer; Andreas Engelhardt; Jan C Krüger; Sebastian Lask; Jan Börgel; Andreas Mügge; Heinz G Endres
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Publication Detail:
Type:  Comparative Study; Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of cardiovascular pharmacology     Volume:  56     ISSN:  1533-4023     ISO Abbreviation:  J. Cardiovasc. Pharmacol.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-20     Completed Date:  2010-11-02     Revised Date:  2013-06-04    
Medline Journal Info:
Nlm Unique ID:  7902492     Medline TA:  J Cardiovasc Pharmacol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  91-7     Citation Subset:  IM    
Affiliation:
Ruhr University Bochum, Cardiovascular Center, St. Josef-Hospital, Bochum, Germany. horst.neubauer@rub.de
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MeSH Terms
Descriptor/Qualifier:
2-Pyridinylmethylsulfinylbenzimidazoles / metabolism,  pharmacology*
Aged
Angioplasty, Balloon, Coronary / methods
Aspirin / therapeutic use
Coronary Artery Disease / therapy
Drug Interactions
Esomeprazole Sodium
Female
Humans
Male
Middle Aged
Multivariate Analysis
Omeprazole / metabolism,  pharmacology
Platelet Aggregation / drug effects
Platelet Aggregation Inhibitors / metabolism,  pharmacology*
Platelet Function Tests
Prospective Studies
Proton Pump Inhibitors / metabolism,  pharmacology*
Regression Analysis
Stents
Ticlopidine / analogs & derivatives*,  metabolism,  pharmacology
Chemical
Reg. No./Substance:
0/2-Pyridinylmethylsulfinylbenzimidazoles; 0/Platelet Aggregation Inhibitors; 0/Proton Pump Inhibitors; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 73590-58-6/Omeprazole; A74586SNO7/clopidogrel; D8TST4O562/pantoprazole; L2C9GWQ43H/Esomeprazole Sodium

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


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