Abstract Background: The CYP2C19*2 polymorphism is significantly associated with residual platelet reactivity (RPR) and maybe a major confounding factor in studies evaluating pharmacological interactions with clopidogrel. Objectives: We sought to evaluate the influence of a proton pump inhibitor (PPI), pantoprazole, indicated as relatively less influent than other PPIs, on the antiplatelet effect of clopidogrel, considering a stratification of the population for the presence of cytochrome 2 C19*2 polymorphism. Methods: 105 patients with ST elevation myocardial infarction (STEMI), treated with percutaneous coronary angioplasty (PCI) and who received dual antiplatelet therapy, were randomized between pantoprazole (n=54) or ranitidine (n=51). RPR was evaluated by Platelet Function Analyzer-100 (PFA-100) with collagen-epinephrine (CEPI) and collagene-ADP (CADP) cartridges and by light transmitted aggregometry with 10 mu M adenosin diphosphate (ADP) and 1 mM arachidonic acid (AA), on 5 (T0) and 30 (T1) days after PCI. Results: Demographic, clinical and procedural data and the prevalence of CYP2C19*2 polymorphism were similar between the two groups. Not statistically differences were observed for CEPI-CT and for the maximal aggregation (MA) values with AA stimulus at both times. We observed a significant increase in MA values with ADP in PPI group at T0 (p=0.01) and T1 (p=0.03). At the multiple regression analysis PPI use remained significantly associated with ADP-MA both at T0 (p=0.05) and T1 (p=0.03). Conclusions: This is the first documentation in a randomized trial, after correction for the bias of CYP2C19*2 polymorphism, that pantoprazole increases the ADP-MA in patients treated with dual antiplatelet therapy.

Pantoprazole significantly interferes with antiplatelet effect of clopidogrel: Results of a pilot randomized trial / M.S. Parri; J. Gianetti; A. Dushpanova; F. Della Pina; C. Saracini; R. Marcucci; B. Giusti; S. Berti.. - In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - ISSN 0167-5273. - STAMPA. - 167:(2012), pp. 2177-2181. [10.1016/j.ijcard.2012.05.080]

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

SARACINI, CLAUDIA;MARCUCCI, ROSSELLA;GIUSTI, BETTI;
2012

Abstract

Abstract Background: The CYP2C19*2 polymorphism is significantly associated with residual platelet reactivity (RPR) and maybe a major confounding factor in studies evaluating pharmacological interactions with clopidogrel. Objectives: We sought to evaluate the influence of a proton pump inhibitor (PPI), pantoprazole, indicated as relatively less influent than other PPIs, on the antiplatelet effect of clopidogrel, considering a stratification of the population for the presence of cytochrome 2 C19*2 polymorphism. Methods: 105 patients with ST elevation myocardial infarction (STEMI), treated with percutaneous coronary angioplasty (PCI) and who received dual antiplatelet therapy, were randomized between pantoprazole (n=54) or ranitidine (n=51). RPR was evaluated by Platelet Function Analyzer-100 (PFA-100) with collagen-epinephrine (CEPI) and collagene-ADP (CADP) cartridges and by light transmitted aggregometry with 10 mu M adenosin diphosphate (ADP) and 1 mM arachidonic acid (AA), on 5 (T0) and 30 (T1) days after PCI. Results: Demographic, clinical and procedural data and the prevalence of CYP2C19*2 polymorphism were similar between the two groups. Not statistically differences were observed for CEPI-CT and for the maximal aggregation (MA) values with AA stimulus at both times. We observed a significant increase in MA values with ADP in PPI group at T0 (p=0.01) and T1 (p=0.03). At the multiple regression analysis PPI use remained significantly associated with ADP-MA both at T0 (p=0.05) and T1 (p=0.03). Conclusions: This is the first documentation in a randomized trial, after correction for the bias of CYP2C19*2 polymorphism, that pantoprazole increases the ADP-MA in patients treated with dual antiplatelet therapy.
2012
167
2177
2181
M.S. Parri; J. Gianetti; A. Dushpanova; F. Della Pina; C. Saracini; R. Marcucci; B. Giusti; S. Berti.
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/779372
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