What question did this study set out to answer?

To determine whether proton pump inhibitors uniformly reduce clopidogrel antiplatelet efficacy via CYP2C19 inhibition or if the interaction varies between omeprazole and pantoprazole.

April 5, 2011European Journal of Gastroenterology & Hepatology

Omeprazole, but not pantoprazole, reduces the antiplatelet effect of clopidogrel

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Why the study?

Does omeprazole compared to pantoprazole reduce the antiplatelet effect of clopidogrel in post-MI patients on dual antiplatelet therapy?

Population

34 consecutive patients undergoing dual antiplatelet therapy 1 month after an acute myocardial infarction

Comparison

Omeprazole 40 mg for 4 weeks added to dual… vs Pantoprazole 40 mg for 4 weeks added to dual…

Design

RCT, randomized to receive either omeprazole or pantoprazole first

Follow-up

4 weeks per treatment period

Authors

RFRicardo Fontes‐CarvalhoGeneral / Preventive / Lipids AAAníbal AlbuquerqueUniversidade Federal do Ceará CACarla AraújoUniversidade do Porto

Discussion

Member takes

Implication

Omeprazole attenuates clopidogrel efficacy post-MI; confirms agent-specific PPI interaction, favoring pantoprazole in DAPT.

Key Points

To determine whether proton pump inhibitors uniformly reduce clopidogrel antiplatelet efficacy via CYP2C19 inhibition or if the interaction varies between omeprazole and pantoprazole.
Prospective randomized crossover trial in 34 consecutive post-myocardial infarction patients receiving dual antiplatelet therapy.
Measured platelet reactivity via VerifyNow across three consecutive conditions: baseline washout without PPI, 4 weeks of omeprazole (40 mg), and 4 weeks of pantoprazole (40 mg), separated by 1-month washout periods.
Omeprazole significantly decreased clopidogrel efficacy, increasing mean P2Y12 reaction units (PRU) from 202 ± 52 without PPI to 235 ± 58 (P < 0.001).
Pantoprazole preserved clopidogrel efficacy, yielding a mean PRU of 215 ± 54 (P = 0.16 compared to baseline).
Clopidogrel nonresponsiveness (PRU > 240) increased from 26% without PPI to 45% during omeprazole coadministration versus 23% during pantoprazole treatment.

Structured PICO

Does omeprazole compared to pantoprazole reduce the antiplatelet effect of clopidogrel in post-MI patients on dual antiplatelet therapy?

Population

34 consecutive patients undergoing dual antiplatelet therapy 1 month after an acute myocardial infarction

Intervention

Omeprazole 40 mg for 4 weeks added to dual antiplatelet therapy

Comparator

Pantoprazole 40 mg for 4 weeks added to dual antiplatelet therapy, and a no-PPI baseline (crossover design with 1-month washout periods)

Outcome

Platelet function measured by P2Y12 reaction units (PRU) using the VerifyNow systemsurrogate

Omeprazole, but not pantoprazole, significantly attenuates the antiplatelet effect of clopidogrel in post-MI patients, suggesting the interaction is not a class effect.

Cite This Study

Fontes‐Carvalho et al. (2011) studied this question.

synapsesocial.com/papers/6a7d40ad2c71273e4183e2be https://doi.org/10.1097/meg.0b013e3283460110

Topics

Dual antiplatelet therapy

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Omeprazole, but not pantoprazole, reduces the antiplatelet effect of clopidogrel

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Omeprazole, but not pantoprazole, reduces the antiplatelet effect of clopidogrel

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider