What is the clinical evidence from this study?

Study design: Other. Population: Patients receiving dual antiplatelet therapy due to prior percutaneous coronary intervention (n=70). Intervention: Omeprazole vs. Rabeprazole. Primary outcome: P2Y12 reaction units (PRUs) measured by VerifyNow assay (p=0.0060).

January 1, 2012Journal of Atherosclerosis and ThrombosisOpen Access

Effects of PPIs and an H2 blocker on the Antiplatelet Function of Clopidogrel in Japanese Patients under Dual Antiplatelet Therapy

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Key result

Omeprazole significantly reduced the antiplatelet effect of clopidogrel compared to rabeprazole, as evidenced by higher P2Y12 reaction units (252.2 vs 216.6, p=0.0060), whereas concomitant use of famotidine had no effect.

Why the study?

Does the use of proton pump inhibitors (omeprazole, rabeprazole) or an H2 blocker (famotidine) reduce the antiplatelet effect of clopidogrel in patients on dual antiplatelet therapy?

Population

55 Japanese patients receiving dual antiplatelet therapy due to prior percutaneous coronary intervention.

Comparison

Omeprazole, rabeprazole, or famotidine added to… vs Rabeprazole, control patients not on PPI/H2…

Design

Cohort

Authors

KYKeiichiro YamaneTenri Hospital YKYoshihiro KatoInterventional / Structural Cardiology JTJunichi TazakiJapanese Red Cross Society Wakayama Medical Center

Discussion

Member takes

Implication

Omeprazole may attenuate clopidogrel efficacy in DAPT; this cohort finding leaves open optimal acid-suppressant selection pending RCTs.

Structured PICO

Does the use of proton pump inhibitors (omeprazole, rabeprazole) or an H2 blocker (famotidine) reduce the antiplatelet effect of clopidogrel in patients on dual antiplatelet therapy?

Population

70 Japanese patients receiving dual antiplatelet therapy after percutaneous coronary intervention were evaluated for platelet aggregability during treatment with proton pump inhibitors or an H2 blocker.

Intervention

Omeprazole, rabeprazole (crossover), or famotidine added to dual antiplatelet therapy.

Comparator

Rabeprazole (compared to omeprazole), control patients not on PPI/H2 blocker (compared to rabeprazole), and baseline (compared to famotidine addition).

Outcome

Platelet aggregability evaluated by an optical aggregometer using collagen as a stimulus and by the VerifyNow P2Y12 assay.surrogate

Main Result

Absolute Event Rate: 252.2% vs 216.6%

p-value: p=0.0060

Omeprazole significantly attenuates the antiplatelet effect of clopidogrel, whereas rabeprazole and famotidine do not appear to have this effect.

Limitations

The sample size was small due to the difficulty of finding suitable patients for the crossover study.
Only 4 patients (16%) switched omeprazole to rabeprazole.
Further investigation is needed, increasing the number of poor metabolizer (PM) patients.

Cite This Study

Yamane et al. (2012) studied Patients receiving dual antiplatelet therapy due to prior percutaneous coronary intervention (n=70). Omeprazole vs. Rabeprazole was evaluated on P2Y12 reaction units (PRUs) measured by VerifyNow assay (p=0.0060). Omeprazole significantly reduced the antiplatelet effect of clopidogrel compared to rabeprazole, as evidenced by higher P2Y12 reaction units (252.2 vs 216.6, p=0.0060), whereas concomitant use of famotidine had no effect.

synapsesocial.com/papers/6aa2bb8a259d37a6a5e569ea https://doi.org/10.5551/jat.11601

Topics

Coronary artery disease Dual antiplatelet therapy

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Effects of PPIs and an H2 blocker on the Antiplatelet Function of Clopidogrel in Japanese Patients under Dual Antiplatelet Therapy

Discussion

Member takes

Implication

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Effects of PPIs and an H2 blocker on the Antiplatelet Function of Clopidogrel in Japanese Patients under Dual Antiplatelet Therapy

Discussion

Member takes

Implication

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider