Advertisement

Click here for more guidelines.

 
 




CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2009; 54:1149-1153, doi:10.1016/j.jacc.2009.05.050
© 2009 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow View Related Cardiosource Journal Scan
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Web of Science (18)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Cuisset, T.
Right arrow Articles by Bonnet, J.-L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Cuisset, T.
Right arrow Articles by Bonnet, J.-L.
Related Collections
Right arrowRelated Article

CLINICAL RESEARCH: ANTIPLATELET THERAPY

Comparison of Omeprazole and Pantoprazole Influence on a High 150-mg Clopidogrel Maintenance Dose

The PACA (Proton Pump Inhibitors And Clopidogrel Association) Prospective Randomized Study

Thomas Cuisset, MD*,{dagger},{ddagger},*, Corinne Frere, MD{dagger},{ddagger}, Jacques Quilici, MD*, Raphael Poyet, MD*, Bénédicte Gaborit, MD{dagger},{ddagger}, Laurent Bali, MD*, Olivier Brissy, MD*, Pierre-Emmanuel Morange, MD, PhD{dagger},{ddagger}, Marie-Christine Alessi, MD, PhD{dagger},{ddagger} and Jean-Louis Bonnet, MD*

* Département de Cardiologie, CHU Timone, Marseille, France
{dagger} Laboratoire d'Hématologie, CHU Timone, Marseille, France
{ddagger} INSERM, UMR 626, Faculté de Médecine, Marseille, France

Manuscript received March 3, 2009; revised manuscript received April 28, 2009, accepted May 4, 2009.

* Reprint requests and correspondence: Dr. Thomas Cuisset, CHU Timone, Cardiology, 264 rue Saint Pierre, Marseille, France 13385 (Email: thomascuisset{at}voila.fr).

Objectives: This study sought to compare the effect of 2 proton pump inhibitors (PPIs) on platelet response to clopidogrel after coronary stenting for non–ST-segment elevation acute coronary syndrome (NSTE ACS).

Background: Use of omeprazole has been reported to significantly decrease the clopidogrel antiplatelet effect because of cytochrome P450 interaction. Because all PPIs are metabolized by CYP2C19, but to a varying degree, we hypothesized that the reported negative omeprazole–clopidogrel drug interaction may not be caused by a class effect.

Methods: A total of 104 patients undergoing coronary stenting for NSTE ACS were prospectively included and randomized to omeprazole or pantoprazole 20 mg. They received at discharge 75-mg aspirin and 150-mg clopidogrel. Platelet reactivity index (PRI) vasoactive stimulated phosphoprotein (VASP) was used to assess clopidogrel response and adenosine diphosphate (ADP)–induced aggregation for platelet reactivity (ADP-Ag).

Results: After 1 month, patients receiving pantoprazole had a significantly better platelet response to clopidogrel as assessed with the PRI VASP: 36 ± 20% versus 48 ± 17% (p = 0.007). We identified more clopidogrel nonresponders in the omeprazole group than in the pantoprazole group: 44% versus 23% (p = 0.04), odds ratio: 2.6 (95% confidence interval: 1.2 to 6.2). Conversely, we did not observe any significant difference in platelet reactivity with ADP-Ag between the omeprazole and pantoprazole groups: 52 ± 15% and 50 ± 18%, respectively (p = 0.29).

Conclusions: The present findings suggest the preferential use of pantoprazole compared with omeprazole in patients receiving clopidogrel to avoid any potential negative interaction with CYP2C19.

Key Words: proton pump inhibitors • clopidogrel response • VASP assay • cytochrome P450 • coronary stenting

Abbreviations and Acronyms
  ADP = adenosine diphosphate
  ADP-Ag = adenosine diphosphate-induced aggregation for platelet reactivity
  MFI = median fluorescence intensity
  NSTE ACS = non–ST-segment elevation acute coronary syndrome
  PPI = proton pump inhibitor
  PRI = platelet reactivity index
  VASP = vasoactive stimulated phosphoprotein


Related Article

Inside This Issue
J. Am. Coll. Cardiol. 2009 54: A27. [Full Text] [PDF]



This article has been cited by other articles:


Home page
Drug Metab. Dispos.Home page
X. Boulenc, N. Djebli, J. Shi, L. Perrin, W. Brian, R. Van Horn, and F. Hurbin
Effects of Omeprazole and Genetic Polymorphism of CYP2C19 on the Clopidogrel Active Metabolite
Drug Metab. Dispos., January 1, 2012; 40(1): 187 - 197.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
J. Silvain, G. Cayla, J.-S. Hulot, J. Finzi, M. Kerneis, S. A. O'Connor, A. Bellemain-Appaix, O. Barthelemy, F. Beygui, J.-P. Collet, et al.
High on-thienopyridine platelet reactivity in elderly coronary patients: the SENIOR-PLATELET study
Eur. Heart J., November 7, 2011; (2011) ehr407v1.
[Abstract] [Full Text] [PDF]


Home page
Evid. Based Med.Home page
J. M. Siller-Matula and G. Delle-Karth
Addition of omeprazole to dual antiplatelet therapy with clopidogrel plus aspirin lowers the risk of upper gastrointestinal bleeding
Evid. Based Med., October 1, 2011; 16(5): 144 - 145.
[Full Text] [PDF]


Home page
Circ Cardiovasc IntervHome page
J. L. Ferreiro, M. Ueno, S. D. Tomasello, D. Capodanno, B. Desai, K. Dharmashankar, N. Seecheran, M. K. Kodali, A. Darlington, J.-P. Pham, et al.
Pharmacodynamic Evaluation of Pantoprazole Therapy on Clopidogrel Effects: Results of a Prospective, Randomized, Crossover Study
Circ Cardiovasc Interv, June 1, 2011; 4(3): 273 - 279.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll Cardiol IntvHome page
U. S. Tantry, D. J. Kereiakes, and P. A. Gurbel
Clopidogrel and Proton Pump Inhibitors: Influence of Pharmacological Interactions on Clinical Outcomes and Mechanistic Explanations
J. Am. Coll. Cardiol. Intv., April 1, 2011; 4(4): 365 - 380.
[Abstract] [Full Text] [PDF]


Home page
Circ Cardiovasc IntervHome page
K. J. Harjai, C. Shenoy, P. Orshaw, S. Usmani, J. Boura, and R. H. Mehta
Clinical Outcomes in Patients With the Concomitant Use of Clopidogrel and Proton Pump Inhibitors After Percutaneous Coronary Intervention: An Analysis From the Guthrie Health Off-Label Stent (GHOST) Investigators
Circ Cardiovasc Interv, April 1, 2011; 4(2): 162 - 170.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
E. R. Bates, W. C. Lau, and D. J. Angiolillo
Clopidogrel-Drug Interactions
J. Am. Coll. Cardiol., March 15, 2011; 57(11): 1251 - 1263.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
T. Simon, P. G. Steg, M. Gilard, D. Blanchard, L. Bonello, M. Hanssen, H. Lardoux, P. Coste, T. Lefevre, E. Drouet, et al.
Clinical Events as a Function of Proton Pump Inhibitor Use, Clopidogrel Use, and Cytochrome P450 2C19 Genotype in a Large Nationwide Cohort of Acute Myocardial Infarction: Results From the French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI) Registry
Circulation, February 8, 2011; 123(5): 474 - 482.
[Abstract] [Full Text] [PDF]


Home page
StrokeHome page
D. N. Juurlink, T. Gomes, M. M. Mamdani, D. J. Gladstone, and M. K. Kapral
The Safety of Proton Pump Inhibitors and Clopidogrel in Patients After Stroke
Stroke, January 1, 2011; 42(1): 128 - 132.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
R. P. Giugliano and E. Braunwald
The Year in Non-ST-Segment Elevation Acute Coronary Syndrome
J. Am. Coll. Cardiol., December 14, 2010; 56(25): 2126 - 2138.
[Full Text] [PDF]


Home page
CirculationHome page
Writing Committee Members, N. S. Abraham, M. A. Hlatky, E. M. Antman, D. L. Bhatt, D. J. Bjorkman, C. B. Clark, C. D. Furberg, D. A. Johnson, C. J. Kahi, et al.
ACCF/ACG/AHA 2010 Expert Consensus Document on the Concomitant Use of Proton Pump Inhibitors and Thienopyridines: A Focused Update of the ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents
Circulation, December 14, 2010; 122(24): 2619 - 2633.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
American College of Cardiology Foundation Task For, N. S. Abraham, M. A. Hlatky, E. M. Antman, D. L. Bhatt, D. J. Bjorkman, C. B. Clark, C. D. Furberg, D. A. Johnson, C. J. Kahi, et al.
ACCF/ACG/AHA 2010 Expert Consensus Document on the Concomitant Use of Proton Pump Inhibitors and Thienopyridines: A Focused Update of the ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use
J. Am. Coll. Cardiol., December 7, 2010; 56(24): 2051 - 2066.
[Full Text] [PDF]


Home page
J CARDIOVASC PHARMACOL THERHome page
M. Tran, J. Tafreshi, and R. G. Pai
Review Article: Combination of Clopidogrel and Proton Pump Inhibitors: Implications for Clinicians
Journal of Cardiovascular Pharmacology and Therapeutics, December 1, 2010; 15(4): 326 - 337.
[Abstract] [PDF]


Home page
The ESC Textbook of Acute and Intensive Cardiac CareHome page
P. R. Sinnaeve and F. J. Van de Werf
Chapter 42 Fibrinolytic, antithrombotic, and antiplatelet drugs in acute coronary syndrome
The ESC Textbook of Acute and Intensive Cardiac Care, December 1, 2010; 1(1): med-9780199584314-chapter - med-9780199584314-chapter.
[Abstract] [Full Text] [PDF]


Home page
Circ Cardiovasc IntervHome page
J. L. Ferreiro, M. Ueno, D. Capodanno, B. Desai, K. Dharmashankar, A. Darlington, R. K. Charlton, T. A. Bass, and D. J. Angiolillo
Pharmacodynamic Effects of Concomitant Versus Staggered Clopidogrel and Omeprazole Intake: Results of a Prospective Randomized Crossover Study
Circ Cardiovasc Interv, October 1, 2010; 3(5): 436 - 441.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
J.-S. Hulot, J.-P. Collet, J. Silvain, A. Pena, A. Bellemain-Appaix, O. Barthelemy, G. Cayla, F. Beygui, and G. Montalescot
Cardiovascular Risk in Clopidogrel-Treated Patients According to Cytochrome P450 2C19*2 Loss-of-Function Allele or Proton Pump Inhibitor Coadministration: A Systematic Meta-Analysis
J. Am. Coll. Cardiol., July 6, 2010; 56(2): 134 - 143.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
S. R. Dixon, C. L. Grines, and W. W. O'Neill
The Year in Interventional Cardiology
J. Am. Coll. Cardiol., May 18, 2010; 55(20): 2272 - 2286.
[Full Text] [PDF]


Home page
The Annals of PharmacotherapyHome page
C. Abel, A. R. Desilets, and K. Willett
Dexlansoprazole in the Treatment of Esophagitis and Gastroesophageal Reflux Disease
Ann. Pharmacother., May 1, 2010; 44(5): 871 - 877.
[Abstract] [Full Text] [PDF]


Home page
Cleveland Clinic Journal of MedicineHome page
J. P. DEPTA and D. L. BHATT
Omeprazole and clopidogrel: Should clinicians be worried?
Cleveland Clinic Journal of Medicine, February 1, 2010; 77(2): 113 - 116.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, G. K. Feld, B. H. Greenberg, J. Hall, M. Hlatky, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, et al.
Highlights of the Year in JACC 2009
J. Am. Coll. Cardiol., January 26, 2010; 55(4): 380 - 407.
[Full Text] [PDF]


Home page
The Annals of PharmacotherapyHome page
N. B Norgard and G. C Wall
Authors' Reply
Ann. Pharmacother., January 1, 2010; 44(1): 226 - 227.
[Full Text] [PDF]


Home page
CirculationHome page
D. N. Juurlink
Proton Pump Inhibitors and Clopidogrel: Putting the Interaction in Perspective
Circulation, December 8, 2009; 120(23): 2310 - 2312.
[Full Text] [PDF]



 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement