Effects of pantoprazole and esomeprazole on platelet inhibition by clopidogrel
Effects of pantoprazole and esomeprazole on platelet inhibition by clopidogrel
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DOI：
10.1016/j.ahj.2008.09.017
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发表时间：
2009-01-01
影响因子：
4.8
通讯作者：
Jilma, Bernd
中科院分区：
文献类型：
--
作者：
Siller-Matula, Jolanta M.;Spiel, Alexander O.;Jilma, Bernd
背景氯吡格雷由CYP 2C 19激活，CYP 2C 19也代谢质子泵抑制剂（PPI）。由于质子泵抑制剂在不同程度上被CYP 2C 19代谢，我们假设报道的奥美拉唑-氯吡格雷药物负相互作用可能不是类效应。方法通过血管扩张剂刺激的磷蛋白磷酸化（VASP）测定和聚集测定评估氯吡格雷的反应性应用多板分析仪对300例接受经皮冠状动脉介入治疗（PCI）的冠心病患者进行血小板反应性检测。（PRI，通过VASP测定评估）几乎相同的住院患者（n = 226; PRI = 51%）或未接受PPI治疗（n = 74; PRI = 49%; P = 0.724）。同样，二磷酸腺苷诱导的血小板聚集在接受或未接受PPI治疗的患者之间没有显著差异（45 vs. 41 U; P = 0.619）。同样，泮托拉唑组患者的PRI或二磷酸腺苷诱导的血小板聚集率也无差异（n = 152; PRI = 50%;聚集= 47 U），艾美拉唑（n = 74; PRI = 54%;聚集= 42 U）或无PPI（n = 74; PRI = 49%;聚集= 41 U;结论与报道的奥美拉唑-氯吡格雷药物相互作用相反，泮托拉唑或埃索美拉唑的摄入与氯吡格雷的不良反应无关。(Am Heart）2009;157：148.e1-148.e5.）
Background Clopidogrel is activated by CYP2C19, which also metabolizes proton pump inhibitors (PPI). As proton pump inhibitors are metabolized to varying degrees by CYP2C19, we hypothesized that the reported negative omeprazole-clopidogrel drug interaction may not be a class effect.Methods Responsiveness to clopidogrel was assessed by the vasodilator-stimulated phosphoprotein phosphorylation (VASP) assay and aggregometry (Multiplate Analyzer) in 300 patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI).Results The mean platelet reactivity index (PRI, assessed by the VASP assay) was nearly the same inpatients with (n = 226; PRI = 51%) or without PPI treatment (n = 74; PRI = 49%; P = .724). Likewise, the adenosine diphosphate-induced platelet aggregation did not differ significantly between patients with or without PPI treatment (45 vs. 41 U; P = .619). Similarly, there was no difference in the PRI or the adenosine diphosphate-induced platelet aggregation between patients with pantoprazole (n = 152; PRI = 50%; aggregation = 47 U), esomeprazole (n = 74; PRI = 54%; aggregation = 42 U), or without PPI (n = 74; PRI = 49%; aggregation = 41 U; P = .382).Conclusion In contrast to the reported negative omeprazole-clopidogrel drug interaction, the intake of pantoprazole or esomeprazole is not associated with impaired response to clopidogrel. (Am Heart) 2009;157:148.e1-148.e5.)