The impact of oral antiplatelet responsiveness on the long-term prognosis after coronary stenting

Foussas, Stefanos; Zairis, Michael N.; Patsourakos, Nikolaos G.; Makrygiannis, Stamatis S.; Adamopoulou, Evdokia N.; Handanis, Stylianos M.; Prekates, A.; Fakiolas, Constantine; Pissimissis, E G; Olympios, Christopher D.; Argyrakis, Spyros K.

doi:10.1016/j.ahj.2007.06.013

Cited by 20 publications

(17 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…11,12 Although a reduction in platelet inhibition would be expected to manifest as a reduction in the clinical efficacy of clopidogrel therapy, recent clinical outcome studies have reported conflicting results. Several small studies [13][14][15] and retrospective analyses of 3 larger population-based studies 16 -18 have reported an increased risk of cardiovascular events for patients receiving combined PPI and clopidogrel compared with clopidogrel alone. In contrast, results and retrospective analyses of 3 large randomized clinical trials of Ͼ41 000 clopidogrel- preliminary results]) have shown no significant effect of concomitant PPI administration on the clinical efficacy of clopidogrel therapy.…”

Section: Editorial See P 468 Clinical Perspective On P 482mentioning

confidence: 99%

Section: Editorial See P 468 Clinical Perspective On P 482mentioning

confidence: 99%

“…11,12 Although a reduction in platelet inhibition would be expected to manifest as a reduction in the clinical efficacy of clopidogrel therapy, recent clinical outcome studies have reported conflicting results. Several small studies [13][14][15] and retrospective analyses of 3 larger population-based studies 16 -18 8,19,20 In light of these conflicting results from controlled clinical trials, further large-scale investigation into the real-world efficacy of PPI and clopidogrel combination therapy is required.The French Registry of Acute-ST-Elevation and Non-STElevation Myocardial Infarction (FAST-MI) gathered comprehensive data on the management and outcomes of patients admitted to intensive care units with definite MIs. 21 The present analysis compared treatment outcomes in patients who did or did not receive clopidogrel and/or PPIs to assess the clinical impact of PPI treatment on the efficacy of clopidogrel therapy, with specific focus on CYP2C19 genetic polymorphisms.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Clinical Events as a Function of Proton Pump Inhibitor Use, Clopidogrel Use, and Cytochrome P450 2C19 Genotype in a Large Nationwide Cohort of Acute Myocardial Infarction

et al. 2011

View full text Add to dashboard Cite

Background-Clopidogrel requires metabolic activation by cytochrome P450 2C19 (CYP2C19). Proton pump inhibitors(PPIs) that inhibit CYP2C19 are commonly coadministered with clopidogrel to reduce the risk of gastrointestinal bleeding. This analysis compares treatment outcomes for patients in the French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI) who did or did not receive clopidogrel and/or PPIs. Methods and Results-The FAST-MI registry included 3670 patients (2744 clopidogrel-and PPI-naïve patients) presenting with definite MI. Patients were categorized according to use of clopidogrel and/or PPI within 48 hours after hospital admission. PPI use was not associated with an increased risk for any of the main in-hospital events (in-hospital survival, reinfarction, stroke, bleeding, and transfusion). Likewise, PPI treatment was not an independent predictor of 1-year survival (hazard ratio, 0.97; 95% confidence interval [CI], 0.87 to 1.08; Pϭ0.57) or 1-year MI, stroke, or death (hazard ratio, 0.98; 95% CI, 0.90 to 1.08; Pϭ0.72). No differences were seen when the type of PPI or CYP2C19 genotype was taken into account. In the propensity-matched cohorts, the odds ratios for major in-hospital events in PPI versus no PPI were 0.29 (95% CI, 0.06 to 1.44) and 1.70 (95% CI, 0.10 to 30.3) for patients with 1 and 2 variant alleles, respectively. Similarly, the hazard ratio for 1-year events in hospital survivors was 0.68 (95% CI, 0.26 to 1.79) and 0.55 (95% CI, 0.06 to 5.30), respectively. Conclusion-PPI use was not associated with an increased risk of cardiovascular events or mortality in patients administered clopidogrel for recent MI, whatever the CYP2C19 genotype, although harm could not be formally excluded in patients with 2 loss-of-function alleles. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00673036. Editorial see p 468 Clinical Perspective on p 482Recent pharmacokinetic and pharmacodynamic studies have investigated the effect of concomitant PPI therapy on the antiplatelet response elicited by clopidogrel. 6 -12 Overall, these studies showed that the coadministration of omeprazole, one of the most potent inhibitors of CYP2C19, was associated with reduced platelet inhibition compared with clopidogrel alone 6,7,10 and that PPI use overall was associated with increased platelet aggregation and was an independent predictor of high residual platelet reactivity in patients receiving clopidogrel. 8,9 However, studies also suggest that less potent inhibitors of CYP2C19 such as pantoprazole do not affect the platelet response to clopidogrel. 11,12 Although a reduction in platelet inhibition would be expected to manifest as a reduction in the clinical efficacy of clopidogrel therapy, recent clinical outcome studies have reported conflicting results. Several small studies [13][14][15] and retrospective analyses of 3 larger population-based studies 16 -18 8,19,20 In light of these conflicting results from controlled clinical trials, further lar...

show abstract

Section: Editorial See P 468 Clinical Perspective On P 482mentioning

confidence: 99%

Section: Editorial See P 468 Clinical Perspective On P 482mentioning

confidence: 99%

“…11,12 Although a reduction in platelet inhibition would be expected to manifest as a reduction in the clinical efficacy of clopidogrel therapy, recent clinical outcome studies have reported conflicting results. Several small studies [13][14][15] and retrospective analyses of 3 larger population-based studies 16 -18 8,19,20 In light of these conflicting results from controlled clinical trials, further large-scale investigation into the real-world efficacy of PPI and clopidogrel combination therapy is required.The French Registry of Acute-ST-Elevation and Non-STElevation Myocardial Infarction (FAST-MI) gathered comprehensive data on the management and outcomes of patients admitted to intensive care units with definite MIs. 21 The present analysis compared treatment outcomes in patients who did or did not receive clopidogrel and/or PPIs to assess the clinical impact of PPI treatment on the efficacy of clopidogrel therapy, with specific focus on CYP2C19 genetic polymorphisms.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Clinical Events as a Function of Proton Pump Inhibitor Use, Clopidogrel Use, and Cytochrome P450 2C19 Genotype in a Large Nationwide Cohort of Acute Myocardial Infarction

et al. 2011

View full text Add to dashboard Cite

show abstract

“…CONCLUSIONS : D'après les résultats de la présente étude, le traitement à l'oméprazole n'avait aucune effet sur l'efficacité clinique de la pharmacothérapie au clopidogrel pendant la première année suivant l'installation réussie d'une EC. and the results on one-year outcome were previously published (11). In summary, from April 2003 through January 2005, 612 consecutive patients who underwent successful CS in the catheterization laboratory of Tzanio Hospital (Piraeus, Greece) due to stable angina or a recent acute coronary syndrome, were studied.…”

Section: Patientsunclassified

“…The database of one recently published study from our own study group (11) afforded us the opportunity to examine the impact of treatment with omeprazole on the clinical effectiveness of clopidogrel drug therapy during the first year after successful CS.…”

mentioning

confidence: 99%

The impact of treatment with omeprazole on the effectiveness of clopidogrel drug therapy during the first year after successful coronary stenting

Zairis

Tsiaousis

Patsourakos

et al. 2010

Canadian Journal of Cardiology

Self Cite

View full text Add to dashboard Cite

Resistance to Antiplatelet Therapy

Gurbel

Tantry

2011

Pharmaceutical Sciences Encyclopedia

View full text Add to dashboard Cite

Currently, 25 million people in the United States use aspirin as an antiplatelet agent to prevent cardiovascular events, whereas between 1998 and 2004, use of clopidogrel had increased over 7 times and the use of clopidogrel with aspirin had increased 16 times in the United States. The “nonresponsiveness or resistance” to antiplatelet therapy is becoming a major concern. Therefore, numerous scientific meetings and hundreds of clinical publications have focused on this phenomenon. However, as this chapter will discuss, the mechanism of antiplatelet resistance and the treatment strategies to address these concerns are still unclear.

show abstract

The impact of oral antiplatelet responsiveness on the long-term prognosis after coronary stenting

Cited by 20 publications

References 14 publications

Clinical Events as a Function of Proton Pump Inhibitor Use, Clopidogrel Use, and Cytochrome P450 2C19 Genotype in a Large Nationwide Cohort of Acute Myocardial Infarction

Clinical Events as a Function of Proton Pump Inhibitor Use, Clopidogrel Use, and Cytochrome P450 2C19 Genotype in a Large Nationwide Cohort of Acute Myocardial Infarction

The impact of treatment with omeprazole on the effectiveness of clopidogrel drug therapy during the first year after successful coronary stenting

Resistance to Antiplatelet Therapy

Contact Info

Product

Resources

About