The efficacy and safety of the short‐term combination therapy with ticagrelor and PPIs or H2RA in patients with acute STEMI who underwent emergency PCI

Abstract

Combination therapy with platelet inhibitors and acid‐suppressive agents is recommended for patients with acute ST‐segment elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention (PCI), but there remains a paucity of data to evaluate both the efficacy and safety of these combinations. In this prospective study, a total of 170 patients with acute STEMI who underwent PCI were divided into four groups: pantoprazole + ticagrelor, omeprazole + ticagrelor, ranitidine + ticagrelor, and ticagrelor only. The risk of PCI, antithrombotic efficacy, cardiac function, and main end points were evaluated and compared. No significant differences were found in infarction‐related artery perfusion indexes (thrombolysis in myocardial infarction [TIMI], corrected TIMI frame count), the incidence of stent thrombosis after PCI, platelet indicators (platelet count, mean platelet volume, and platelet distribution width), platelet activation (P‐selectin and glycoprotein IIb/IIIa levels), platelet aggregation (thrombelastography indicators, such as ADP% and MAADP), myocardial necrosis biomarker (creatine kinase isoenzyme‐MB and cardiac troponin I) levels, brain natriuretic peptide levels, the incidence of ischemic end point events, and the incidence of other tissue and organ bleeding events among the four groups. The incidence of gastrointestinal (GI) bleeding events in the proton pump‐inhibitor (PPI) group was significantly lower than that in the control group, whereas in the H2 receptor antagonist (H2RA) group it was not significantly different from the control group. The short‐term combination therapy with ticagrelor and PPIs or H2RA is safe and effective in patients with acute STEMI after PCI. In addition, the PPIs combined with ticagrelor could reduce the incidence of GI bleeding events without increasing the incidence of ischemic events.

Proton pump inhibitors and gastroprotection in patients treated with antithrombotic drugs: A cardiologic point of view

“…In a single-center prospective sub-study of a randomized trial on 231 patients completing 1-year antiplatelet therapy after coronary aortic bypass graft (CABG), severe upper GI mucosal lesions were more frequently observed in patients treated with ticagrelor plus aspirin and aspirin monotherapy than in patients treated with ticagrelor monotherapy[ 102 ]. In a prospective study[ 103 ], patients with acute MI who underwent PCI and treated with ticagrelor were divided into four groups: Pantoprazole, omeprazole, ranitidine, and no gastroprotective treatment. No significant differences were found in infarction related artery perfusion indexes, incidence of stent thrombosis, platelet indicators, platelet activation and aggregation, myocardial necrosis biomarkers and brain natriuretic peptide levels, and incidence of ischemic endpoint events and other tissue and organ bleeding events[ 103 ].…”

“…In a prospective study[ 103 ], patients with acute MI who underwent PCI and treated with ticagrelor were divided into four groups: Pantoprazole, omeprazole, ranitidine, and no gastroprotective treatment. No significant differences were found in infarction related artery perfusion indexes, incidence of stent thrombosis, platelet indicators, platelet activation and aggregation, myocardial necrosis biomarkers and brain natriuretic peptide levels, and incidence of ischemic endpoint events and other tissue and organ bleeding events[ 103 ]. A sub-analysis of the randomized GLOBAL LEADERS trial[ 104 ] compared the experimental antiplatelet arm (23-mo ticagrelor monotherapy following 1-mo DAPT) with the reference arm (12-mo aspirin monotherapy following 12-mo DAPT) after PCI.…”

“…Ranitidine, besides, significantly interferes with the antiplatelet activity of the LDA, probably reducing its intestinal absorption, although it does not seem to attenuate the antiplatelet power of clopidogrel in vitro [ 130 , 131 ]. The incidence of GIB events in the PPI group was significantly lower than that in controls in patients treated with ticagrelor, whereas in the H 2 RA group no significant difference was observed[ 103 ]. In a study, LDA users with a history of peptic ulcers who did not have gastroduodenal mucosal breaks at initial endoscopy were randomly assigned to receive famotidine (20 mg bid) or omeprazole (20 mg qd) for 6 mo.…”

The roles of Th cells in myocardial infarction

“…This process often stems from the rupture or erosion of vulnerable, lipid-rich atherosclerotic coronary plaques, allowing blood to interact with hyperthrombotic core and matrix components within the plaque region [ 2 ]. Complete closure due to thrombus and plaque typically manifests as ST-segment elevation myocardial infarction (STEMI) [ 3 ]. Conversely, partial closure, or closure in the presence of collateral circulation, can lead to non-ST-segment elevation myocardial infarction (non-STEMI) or unstable angina pectoris [ 4 ].…”