Pantoprazole Does Not Reduce the Antiplatelet Effect of Clopidogrel: A Randomized Controlled Trial in Korea

• Published in: Gut and liver 2017, 11(4), , pp.504-511
• Main Authors: Choi, Yoon Jin, Kim, Nayoung, Jang, In-Jin, Cho, Joo-Youn, Nam, Ryoung Hee, Park, Ji Hyun, Jo, Hyun Jin, Yoon, Hyuk, Shin, Cheol Min, Park, Young Soo, Lee, Dong Ho, Jung, Hyun Chae
• Format: Article
• Language: English
• Subjects: 2-Pyridinylmethylsulfinylbenzimidazoles - pharmacology; Acute Coronary Syndrome - drug therapy; Acute Coronary Syndrome - genetics; Aged; Clopidogrel; clopidogrel low response; Cytochrome P-450 CYP2C19 - analysis; Drug Interactions; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Original; Pantoprazole; Platelet Aggregation - drug effects; Platelet Aggregation Inhibitors - pharmacology; Platelet Function Tests; polymorphism; proton pump inhibitors; Ranitidine - pharmacology; Republic of Korea; Single-Blind Method; Ticlopidine - analogs & derivatives; Ticlopidine - pharmacology; 내과학
• ISSN: 1976-2283; 2005-1212
• DOI: 10.5009/gnl16352

Concerns that proton pump inhibitors (PPIs) diminish the efficacy of clopidogrel could hamper the appropriate prescription of PPIs. We evaluated the influence of pantoprazole on the antiplatelet effect of clopidogrel compared with ranitidine, which is regarded as safe, after stratification of the population according to the presence of a cytochrome (CYP) 2C19 polymorphism in Korea. Forty patients who underwent dual antiplatelet therapy were randomized to receive pantoprazole (n=20) or ranitidine (n=20). Platelet aggregation was evaluated by impedance aggregometry at baseline (D0) and 8 days after acid-lowering treatments (D9). CYP2C19 was genotyped by polymerase chain reaction-restriction fragment length polymorphism. After co-treatment, the percentage of clopidogrel low-response was 11.1% (2/18) in the pantoprazole group and 10.5% (2/19) in the ranitidine group (p=0.954). The impedance values with adenosine diphosphate stimulus after acid-lowering treatments did not significantly differ between the two groups. In a multiple regression analysis, only ST-elevation myocardial infarction was marginally associated with a reduced antiplatelet effect (odds ratio, 12.07; 95% confidence interval, 0.84 to 173.78). However, pantoprazole use did not affect the antiplatelet effect after correction for the polymorphism. This study showed that pantoprazole does not increase platelet aggregation in patients receiving dual antiplatelet therapy (ClinicalTrials.gov number: NCT02733640).