Platelet activity associated with concomitant use of clopidogrel and proton pump inhibitors in children with cardiovascular disease.
Platelet activity associated with concomitant use of clopidogrel and proton pump inhibitors in children with cardiovascular disease.
复制标题
患有心血管疾病的儿童同时使用氯吡格雷和质子泵抑制剂与血小板活性相关。
DOI：
10.1111/j.1747-0803.2010.00461.x
复制
发表时间：
2010
影响因子：
0.3
通讯作者：
Li,JenniferS
中科院分区：
文献类型：
--
作者：
Pasquali,SaraK;Yow,Eric;Jennings,LisaK;Li,JenniferS
目的：评价氯吡格雷联合氯吡格雷和质子泵抑制剂治疗有动脉血栓风险的儿童在氯吡格雷(PICOLO)试验中的儿童血小板抑制与单用氯吡格雷(PICOLO)试验的儿童的血小板活性的相关性。设计：在PICOLO试验中随机选择接受积极治疗的患者0-24 。结果：共纳入49例患者(仅44例氯吡格雷，5例氯吡格雷+PPI)；中位年龄38天(四分位数范围17-157天)。每组中的大多数患者都接受了体动脉到肺动脉的分流。与氯吡格雷组相比，氯吡格雷+PPI组患者总体血小板最大聚集抑制百分率(中位数6%，IQR0~44%比49%，IQR 19~63%，P=0.09)明显降低(中位数25%，IQR 3~45%比53%，IQR 38~65%，P=0.04)。结论：PPI+氯吡格雷联合应用可能与心脏病儿童的血小板抑制降低有关。有必要在更大的人群中进行进一步的研究，并评估相关的临床结果。
Context.In adults with acute coronary syndrome, decreased platelet inhibition associated with concomitant use of clopidogrel and proton pump inhibitors (PPI) has been reported.Objective.To evaluate platelet activity associated with PPI + clopidogrel vs. clopidogrel alone in children enrolled in the Platelet Inhibition in Children On cLOpidogrel (PICOLO) trial of clopidogrel in children with a cardiac condition at risk for arterial thrombosis.Design.Patients 0–24 m randomized to active therapy in the PICOLO trial were included in the present analysis. Platelet aggregation inhibition at baseline and steady state were evaluated in patients taking clopidogrel + PPI vs. clopidogrel only in the overall cohort and sub‐group of clopidogrel responders.Results.A total of 49 patients were included (44 clopidogrel only, five clopidogrel + PPI); median age 38 days (interquartile range [IQR] 17–157 days). The majority of patients in each group had undergone systemic‐to‐pulmonary artery shunt. Compared with the clopidogrel group, patients in the clopidogrel + PPI group had a trend toward lower percent inhibition of maximum extent of platelet aggregation overall (median 6%, IQR 0–44% vs. 49%, IQR 19–63%,P= 0.09), and a significant reduction in the clopidogrel responders sub‐group (median 25%, IQR 3–45% vs. 53%, IQR 38–65%,P= 0.04). There was no difference in percent inhibition of rate of platelet aggregation.Conclusions.Concomitant use of PPI + clopidogrel may be associated with decreased platelet inhibition in children with cardiac disease. Further study in a larger population and assessment of associated clinical outcomes is warranted.