Antiaggregation effect of clopidogrel in coronary heart disease patients using omeprazole

Abstract

BackgroundAntiplatelet agents used in coronary heart disease (CHD) cause gastrointestinal side effects. Omeprazole can prevent and cure these antiplatelet side effects. Clopidogrel combined with aspirin increases the risk of gastrointestinal tract ulcers and bleeding. This research studied the effect of omeprazole on the antiplatelet effect of clopidogrel.MethodsCHD patients using clopidogrel and aspirin receive omeprazole 20 mg in a single dose for 10 days. Platelet antiaggregation point for clopidogrel was measured using VerifyNow P2Y12. The cutoff points used were: low on treatment platelet reactivity (LPR) <85 P2Y12 reaction unit (PRU), normal on treatment platelet reactivity (NPR) 85–208 PRU, and high on treatment platelet reactivity (HPR) >208 PRU.ResultsUsing the paired t-test PRU points pre- and post-omeprazole were 154 ± 85.89 PRU and 169.4 ± 56.15 PRU, respectively. The PRU points were consistent or decreased from the previous PRU points below the HPR cutoff (p: 0.215; >0.05). Before omeprazole use, five patients were categorized as NPR, two patients as LPR, and three patients as HPR. After omeprazole use, two patients, each from HPR and NPR category had a PRU point >208; the rest showed results below the HPR point.ConclusionsIn this study the PRU points of clopidogrel after omeprazole use showed a PRU <208. The hypothesis that omeprazole may reduce the antiaggregation effect of clopidogrel as shown by the increase in PRU above the cutoff points >208 PRU (HPR) was not proven.

Systematic Review and Meta-analysis: The Effects of Prophylactic Proton Pump Inhibitor Treatment in Patients With Coronary Heart Disease Receiving Dual Antiplatelet Therapy

“…In the RCT study, patients were stratified by platelet aggregation inhibition rates, and no significance was found between the highest and lowest groups, which represent patients with a high risk of bleeding or thrombosis due to the efficacy of clopidogrel. Data from several observational studies 52,55,59,60 indicated no significant differences between the platelet aggregation function in patients treated with omeprazole and a control group. The treatment duration ranged from 2 days to 2 years in these studies.…”

“…9–12,16–51 The qualitative assessment of the platelet function test included 18 studies. 11,17,23,24,37,50,52–63 The PRISMA flow diagram (Fig. 1) shows the complete screening process, including the reasons for exclusion.…”

“…A total of 17,389 patients (5573 patients treated with PPIs and 11,822 patients not treated with PPIs) from 6 RCTs 11,37,50,54,58,63 and 12 observational studies 17,23,24,52,53,[55][56][57][59][60][61][62] were included in the qualitative review of the platelet function test outcome. The platelet function test was performed 1 hour to 2 years after DAPT with or without PPIs.…”