What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary artery disease requiring percutaneous coronary intervention and dual antiplatelet therapy (n=262). Intervention: Tegoprazan vs. Proton-pump inhibitors (PPIs). Primary outcome: Platelet reaction unit (PRU) value at 3 months (Mean difference -4, 95% CI -23 to 15, p=0.659).

March 25, 2025Open Access

Effect of tegoprazan on temporal variability of platelet reactivity in patients treated with clopidogrel after coronary stenting

Q: What does this research mean for the field?

Tegoprazan results in similar platelet reactivity compared to proton-pump inhibitors at 3, 6, and 12 months in patients receiving clopidogrel after percutaneous coronary intervention. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Tegoprazan resulted in similar platelet reactivity compared to proton-pump inhibitors at 3, 6, and 12 months in patients receiving clopidogrel after percutaneous coronary intervention.

Study Design

Type

Cohort (n=262)

Multicenter

Structured PICO

Does tegoprazan compared to PPIs affect platelet reactivity in patients treated with clopidogrel after coronary stenting?

Population

262 patients who underwent percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation and received dual antiplatelet therapy (aspirin and clopidogrel), mean age 65.4, 73.7% male, single-center in Korea.

Intervention

Tegoprazan combined with dual antiplatelet therapy (aspirin and clopidogrel) after PCI.

Comparator

Proton-pump inhibitors (PPIs) combined with dual antiplatelet therapy (aspirin and clopidogrel) after PCI.

Outcome

Platelet reaction unit (PRU) values at 3, 6, and 12 months after PCI measured using VerifyNow P2Y12 assays.surrogate

Tegoprazan does not significantly affect clopidogrel-induced platelet reactivity compared to traditional PPIs, suggesting it is a safe gastroprotective alternative for patients on DAPT after PCI.

Main Result

Effect estimate: Mean difference -4 (95% CI -23 to 15)

Absolute Event Rate: 157% vs 162%

p-value: p=0.659

Limitations

Retrospective analysis with a relatively small study population derived from a single center
Medication adherence and tolerability were not evaluated
Potential interactions with food or other medications were not considered
Baseline PRU data were available for only a subset of the study population
Small sample sizes within each PPI subgroup precluded detailed analysis
Genetic polymorphisms influencing antiplatelet function were not investigated

Abstract

BACKGROUND/AIMS: Data on the interactions between clopidogrel and tegoprazan are limited. We compared the effects of tegoprazan and proton-pump inhibitors (PPIs) on platelet reactivity. METHODS: Using database data from March 2020 to January 2023, we retrospectively evaluated 262 patients who were taking either tegoprazan (n = 107) or PPIs (n = 155) combined with dual antiplatelet therapy, including aspirin and clopidogrel, after percutaneous coronary intervention. Platelet reactivity was assessed using VerifyNow P2Y12 assays. RESULTS: Platelet reaction unit (PRU) values at 3 (157 ± 8 vs. 162 ± 6, p = 0.659), 6 (167 ± 9 vs. 158 ± 7, p = 0.370), and 12 months (155 ± 10 vs. 164 ± 7, p = 0.448) were similar between groups. The prevalence of high on-treatment platelet reactivity, defined as ≥ 253 PRU, was also similar between the groups at 3 (10.3% vs. 10.2%, p = 0.976), 6 (7.0% vs. 8.2%, p = 1.000), and 12 months (4.3% vs. 9.0%, p = 0.503). CONCLUSION: There was no significant difference in platelet reactivity between the tegoprazan and PPI groups in patients undergoing PCI and receiving dual antiplatelet therapy with clopidogrel.

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