Pantoprazole significantly interferes with antiplatelet effect of clopidogrel: Results of a pilot randomized trial

Parri, Maria Serena; Gianetti, Jacopo; Dushpanova, Anar; Pina, Francesca Della; Saracini, Claudia; Marcucci, Rossella; Giusti, Betti; Berti, Sérgio

doi:10.1016/j.ijcard.2012.05.080

Cited by 25 publications

(23 citation statements)

References 28 publications

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“…One study excluded patients with HTPR at baseline, which was defined as adenosine diphosphateinduced platelet aggregation (ADP-PA) > 46% [10]. All other studies reporting on this outcome did not exclude patients based on baseline platelet reactivity or genetic predisposition to clopidogrel resistance [9,11,13,14,17,20,22].…”

Section: Resultsmentioning

confidence: 99%

“…GI complications were similarly defined, mostly including clinical or laboratory evidence of GI bleeding (hematemesis or melena) or an otherwise unexplained drop in hemoglobin [13,23] with 3 studies reporting on endoscopic erosions/ulcers [9,20,21]. Most of the included RCTs reported MACE as a combination of death, myocardial infarction or re-infarction, stent thrombosis, stroke, and/or hospitalization for cardiovascular reasons [11,20,21]. Two studies differed in their MACE definitions.…”

Section: Resultsmentioning

confidence: 99%

“…HTPR was defined based on the platelet function assay used but included PPI, proton pump inhibitors; H2RA, Histamine 2 receptor antagonists; CAD, coronary artery disease; ACS, acute coronary syndrome; GI, gastrointestinal complications; MACE, major adverse cardiovascular events; HTPR, high on-treatment platelet reactivity; DAPT, dual antiplatelet therapy; N/A, not/applicable, outcomes not studied in trials or p values not reported; ns, not significant. * Each criterion has been evaluated as being "high," "low," or "unclear" regarding the risk of bias following the guidelines of the cochrane collaboration's tool for assessing risk of bias in randomised trials [11]. The domains were evaluated as "unclear" when the methods used for the randomization or treatment allocation were not clearly reported.…”

Section: Resultsmentioning

confidence: 99%

“…The incremental benefit and cost effectiveness of PPIs have therefore been questioned when compared to other gastric acid suppressants, particularly Histamine 2 receptor antagonists (H2RAs) [8]. Prior observational studies have suggested that H2RAs are associated with a lower risk of rehospitalization post-ACS and of target vessel revascularization [4], possibly because H2RAs allow for greater platelet inhibition [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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H2 Receptor Antagonists versus Proton Pump Inhibitors in Patients on Dual Antiplatelet Therapy for Coronary Artery Disease: A Systematic Review

Almufleh¹,

Ramirez²,

So³

et al. 2018

Cardiology

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Objectives: Mitigating the gastrointestinal (GI) bleeding risks of dual antiplatelet therapy (DAPT) is a common clinical concern. While proton pump inhibitors (PPIs) remain the most effective therapy, their adverse events warrant considering alternatives, including Histamine 2 receptor antagonists (H2RAs). Methods: We searched for randomized controlled trials in MEDLINE, EMBASE, PubMed, and Cochrane Central Register of Controlled Trials, published from 1980 to 2016. After screening, 10 trials were eligible. We compared PPIs to H2RAs in patients on DAPT in terms of 2 clinical and one laboratory outcomes; GI complications, major adverse cardiovascular events (MACE) and high on-treatment platelet reactivity (HTPR). Clinical and statistical inter-study heterogeneity was low for all 3 outcomes (I² = 0%, p > 0.05 for all). Results: Fixed effects meta-analysis suggested that PPIs were superior to H2RAs in preventing GI complications (OR 0.28, 95% CI 0.17–0.48) but with higher risk of HTPR (OR 1.28, 95% CI 1.030–1.60) though without a higher incidence of MACE (OR 0.99, 95% CI 0.55–1.77). Conclusions: PPIs are superior to H2RAs for gastroprotection in patients on DAPT. However, PPIs are associated with HTPR, with no significant difference demonstrated in MACE. Based on currently available data, the use of PPIs may be warranted in selected patients on DAPT deemed at risk for GI complications.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

H2 Receptor Antagonists versus Proton Pump Inhibitors in Patients on Dual Antiplatelet Therapy for Coronary Artery Disease: A Systematic Review

Almufleh¹,

Ramirez²,

So³

et al. 2018

Cardiology

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show abstract

“…A influência da presença (homo ou heterozigotos) versus ausência (genótipo "selvagem") nos resultados da meta principal é descrita no item a seguir ("Análise de subgrupos"). Em relação ao pantoprazol, apesar da sugestão de menor interação entre esse IBP e o clopidogrel, essa afirmação não encontra respaldo consensual na literatura 41,44 . Adicionalmente, evidências clínicas sugerem aumento similar de eventos clínicos em pacientes utilizando omeprazol ou pantoprazol, em relação à não utilização de IBP, em pacientes submetidos à terapêutica com clopidogrel 51,53 .…”

Section: Financiamentounclassified

Comparação entre a ranitidina e o omeprazol em relação a possíveis interações medicamentosas com o clopidogrel em pacientes portadores de doenças arterial coronária estável

Furtado¹

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Appropriateness of gastrointestinal prophylaxis use during hospitalization in patients with acute myocardial infarction: Analysis from the China Acute Myocardial Infarction Registry

Shi

Yang

et al. 2020

Clinical Cardiology

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BackgroundThe current status of gastrointestinal prophylaxis (GIP) usage and its effects on hospitalized acute myocardial infarction (AMI) patients is not clear. We investigate the appropriateness of GIP usage and its relationship with clinical events in China.HypothesisAppropriate use of GIP is not associated with increased adverse outcomes.MethodsFrom January 2013 to September 2014, a total of 24 001 consecutive patients from 108 hospitals with AMI in China Acute Myocardial Infarction (CAMI) registry were analyzed. The appropriateness of GIP was evaluated using the current American College of Cardiology Foundation/American Heart Association (ACCF/AHA) and European Society of Cardiology (ESC) guidelines. The primary endpoint was in‐hospital gastrointestinal bleeding (GIB), while the secondary endpoints were in‐hospital and 2‐year follow‐up net adverse cardiovascular and cerebrovascular events (NACCE). Multivariate logistic regression analysis and Cox proportional hazard models were used to assess the effect of appropriate GIP.ResultsThere were 16 413 (68.38%) AMI patients co‐medicated with GIP. Among 108 involved hospitals, only 35 (32.4%) hospitals prescribed more than 50% appropriate GIP. Totally, 59.7% (14 340) AMI patients received inappropriate GIP. Inappropriate GIP use was independently associated with use of GPIIb/IIIa receptor inhibitor and primary percutaneous coronary intervention (PCI). Moreover, appropriate GIP use was associated with decreased GIB risk (OR: 0.692, 95% CI: 0.507‐0.944, P = .0202) during hospitalization, while not with increased in‐hospital and 2‐year follow‐up NACCE.ConclusionThe use of GIP is prevalent in patients with AMI in China but only 40% of hospitalized patients received appropriate GIP. Appropriate prophylactic therapy was associated with decreased GIB risk during hospitalization.

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Pantoprazole significantly interferes with antiplatelet effect of clopidogrel: Results of a pilot randomized trial

Cited by 25 publications

References 28 publications

H2 Receptor Antagonists versus Proton Pump Inhibitors in Patients on Dual Antiplatelet Therapy for Coronary Artery Disease: A Systematic Review

H2 Receptor Antagonists versus Proton Pump Inhibitors in Patients on Dual Antiplatelet Therapy for Coronary Artery Disease: A Systematic Review

Comparação entre a ranitidina e o omeprazol em relação a possíveis interações medicamentosas com o clopidogrel em pacientes portadores de doenças arterial coronária estável

Appropriateness of gastrointestinal prophylaxis use during hospitalization in patients with acute myocardial infarction: Analysis from the China Acute Myocardial Infarction Registry

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