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Pantoprazole Does Not Reduce the Antiplatelet Effect of Clopidogrel: A Randomized Controlled Trial in Korea
Gut and Liver ; : 504-511, 2017.
Article in English | WPRIM | ID: wpr-88946
ABSTRACT
BACKGROUND/

AIMS:

Concerns that proton pump inhibitors (PPIs) diminish the efficacy of clopidogrel could hamper the appropriate prescription of PPIs. We evaluated the influence of pantoprazole on the antiplatelet effect of clopidogrel compared with ranitidine, which is regarded as safe, after stratification of the population according to the presence of a cytochrome (CYP) 2C19 polymorphism in Korea.

METHODS:

Forty patients who underwent dual antiplatelet therapy were randomized to receive pantoprazole (n=20) or ranitidine (n=20). Platelet aggregation was evaluated by impedance aggregometry at baseline (D0) and 8 days after acid-lowering treatments (D9). CYP2C19 was genotyped by polymerase chain reaction restriction fragment length polymorphism.

RESULTS:

After co-treatment, the percentage of clopidogrel low-response was 11.1% (2/18) in the pantoprazole group and 10.5% (2/19) in the ranitidine group (p=0.954). The impedance values with adenosine diphosphate stimulus after acid-lowering treatments did not significantly differ between the two groups. In a multiple regression analysis, only ST-elevation myocardial infarction was marginally associated with a reduced antiplatelet effect (odds ratio, 12.07; 95% confidence interval, 0.84 to 173.78). However, pantoprazole use did not affect the antiplatelet effect after correction for the CYP2C19 polymorphism.

CONCLUSIONS:

This study showed that pantoprazole does not increase platelet aggregation in patients receiving dual antiplatelet therapy (ClinicalTrials.gov number NCT02733640).
Subject(s)

Full text: Available Index: WPRIM (Western Pacific) Main subject: Ranitidine / Polymorphism, Restriction Fragment Length / Adenosine Diphosphate / Platelet Aggregation / Polymerase Chain Reaction / Electric Impedance / Cytochromes / Drug Interactions / Proton Pump Inhibitors / Prescriptions Type of study: Controlled clinical trial Limits: Humans Country/Region as subject: Asia Language: English Journal: Gut and Liver Year: 2017 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Ranitidine / Polymorphism, Restriction Fragment Length / Adenosine Diphosphate / Platelet Aggregation / Polymerase Chain Reaction / Electric Impedance / Cytochromes / Drug Interactions / Proton Pump Inhibitors / Prescriptions Type of study: Controlled clinical trial Limits: Humans Country/Region as subject: Asia Language: English Journal: Gut and Liver Year: 2017 Type: Article