Effect of clopidogrel with or without omeprazole in patients with carotid artery stenting / Efecto del clopidogrel con o sin omeprazol en pacientes con stent en la arteria carótida

BACKGROUND: Recent concerns have been raised about the potential for proton pump inhibitors (PPIs) to blunt the efficacy of clopidogrel. We observed the effect of clopidogrel plus aspirin with or without omeprazole in patients with carotid stenoses after they received placement of carotid stents. METHODS: Sixty-four consecutive patients treated with percutaneous carotid artery stenting (CAS) comprised the sample. All enrolled patients underwent the C13 urea breath test (C13 UBT) before CAS. Patients with Helicobacter pylori infection and a history of peptic ulcer were assigned dual antiplatelet combination with omeprazole. Others received dual antiplatelet without omeprazole. Transcranial Doppler and ultrasonography were performed to assess the middle cerebral artery and carotid artery in follow-up at three months and six months. RESULTS: Eight patients had gastrointestinal bleeding; the event rate was 22.6% without omeprazole and 3.8% with omeprazole. The rate of gastrointestinal bleeding was reduced with omeprazole as compared without omeprazole (p = 0.026, p < 0.05). The two groups did not differ significantly in the rate of instent restenosis and thrombus through transcranial Doppler and ultrasonography. CONCLUSION: Among patients receiving dual antiplatelet therapy, prophylactic use of omeprazole reduced the rate of upper gastrointestinal bleeding. There was no apparent interaction between clopidogrel and omeprazole in patients with carotid artery stenting.

ANTECEDENTES: Recientemente se han expresado preocupaciones acerca de la posibilidad de que los inhibidores de la bomba de protones (IBP) para debilitar la eficacia del clopidogrel. Observamos el efecto del clopidogrel más aspirina con o sin omeprazol en pacientes con estenosis de la arteria carótida después de que recibieran la colocación de stents carotídeos. MÉTODOS: Sesenta y cuatro pacientes consecutivos tratados con stent percutáneo de la arteria carótida (SAC) fueron seleccionados para formar la muestra. A todos los pacientes inscritos se les realizó la prueba de aliento con urea C13 (C13 UBT) antes de CAS. A pacientes con infección por Helicobacter pylori y antecedentes de úlcera péptica les fue asignada una combinación antiplaquetaria dual con omeprazol. Otros recibieron tratamiento antiplaquetario dual sin omeprazol. Se realizaron una prueba Transcranial Doppler y una ultrasonografía a fin de evaluar la arteria cerebral media y la arteria carótida en seguimientos a los tres meses y a los seis meses. RESULTADOS: Ocho pacientes tuvieron hemorragia gastrointerstinal; la tasa de eventos fue 22.6% sin omeprazol y 3.8% con omeprazol. La tasa de hemorragia gastrointerstinal se redujo con omeprazol en comparación con la obtenida sin omeprazol (p = 0,026, p < 0.05). Los dos grupos no difirieron significativamente con respecto a la tasa de restenosis en stent y trombos a través de la prueba Transcranial Doppler y la ultrasonografía. CONCLUSIÓN: Entre los pacientes que reciben terapia antiplaquetaria dual, el uso profiláctico de omeprazol redujo la tasa de hemorragia gastrointestinal superior. No hubo interacción ostensible entre el clopidogrel y el omeprazol en pacientes con stent de la arteria carótida.

Left ventricular functional changes of stunned myocardium during perioperation of coronary artery bypass graft surgery / 中国地方病学杂志

ObjectiveTo evaluate the functional changes of stunned myocardium before and after coronary artery bypass graft(CABG) treatment,and clear the meaning of revascularization which CABG has brought to patients with diffused vascular changes.MethodsA total of 36 patients with 99％ diffused coronary artery stenosis in left anterior descending branch underwent non-pump CABG treatment in the Department of Cardiothoracic Surgery the First affiliated hospital of Harbin Medical University.Real-time three-dimensional echocardiography (RT3DE) was repeatedly performed 1 week before operation and 10 days,1 month,and 3 months after CABG.Regional diastolic volumes,systolic volumes,ejection fractions,regional stroke volume to global diastolic volume and the values of abnormal segments before and after CABG were studied.ResultsOne week before operation and 10 days,1 month and 3 months after CABG,the differences of volumes between groups in the last phases of diastole and systolic were statistically significant in anterior wall basement segment,anterior septal basement segment,anterior wall intercalary segment,anterior septal intercalary segment,anterior wall of apex cordis and septation of apex cordis(F =3.51,3.55,4.08,4.05,2.98,3.01,all P ＜ 0.05; F =4.51,4.55,4.08,3.00,2.96,2.99,all P ＜ 0.05).The values of the six segments mentioned above,3 months after operation[(6.74 ± 1.23),(6.64 ± 1.21),(6.02 ± 1.10),(5.95 ± 1.09),(5.82 ± 1.06),(5.10 ± 0.93)ml; (2.74 ± 0.50),(2.69 ± 0.49),(2.51 ± 0.46),(2.32 ± 0.42),(2.36 ± 0.43),(2.03 ± 0.37)ml] were compared with those of 1 week before operation[(8.33 ± 1.52),(8.20 ± 1.50),(7.43 ± 1.36),(7.36 ± 1.34),(7.19 ± 1.31),(6.29 ± 1.15)ml; (4.94 ± 0.90),(4.85 ± 0.88),(4.53 ± 0.83),(4.18 ± 0.76),(4.25 ± 0.78 ),(3.65 ± 0.67)ml],the differences were statistically significant (all P ＜ 0.05); the differences between groups in regional ejection fractions,regional-global ejection fractions were statistically significant(F =4.56,4.88,4.28,3.15,2.93,2.88,P ＜ 0.01 or ＜ 0.05; F =5.56,5.28,4.98,5.15,3.03,2.78,P ＜ 0.01 or ＜ 0.05).Compared with 1 week before the operation, 1 month after the operation in regional ejection fractions,10 days,1 month in regionalglobal ejection fractions after the operation,4 segments of them were significantly improved(all P ＜ 0.05) and 3 months after operation,all the 6 segments had been improved significantly(all P ＜ 0.05).The maximum volume of the sum of group difference of the 6 segments and the 4 segments in the last phase of diastole was statistically significant(F =2.58,5.81,P ＜ 0.05 or ＜ 0.01 ),and the summation began to decrease 10 days after the operation.The values of 3 months after operation[ (36.27 ± 1.10),(25.35 ± 1.16)ml] were compared with that of 1 week before operation[ (44.80 ± 1.36),(31.32 ± 1.43)ml ] the difference was statistically significant (all P＜ 0.05).The maximum volume summafion comparisons of 6 segments and 4 segments in the last phase of systolic had statistical significance(F =5.77,5.57,all P ＜ 0.01 ),and 10 days after the operation,the summation began to decrease.The values of 1 month[(16.4 0 ± 0.48),(11.58 ±0.51 )ml],and 3 months after operation[ (14.65 ± 0.45),(10.26 ± 0.46)ml],were compared with those of 1 week before operation[ (26.40 ± 0.80),(18.50 ± 0.84)ml],the differences were statistically significant (all P ＜ 0.05).ConclusionsStunned myocardium can be improved through CABG in myocardium systolic,diastole function and ejection fractions of the relevant segments and all of this have proved that patients undergoing CABG revascularization can improve the heart function of the ischemic area.