PPIs reduces the antiplatelt effects of clopidogrel: According to a 2007 survey, clopidogrel is the...
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Transcript of PPIs reduces the antiplatelt effects of clopidogrel: According to a 2007 survey, clopidogrel is the...
PPIs reduces the antiplatelt effects of clopidogrel:
•According to a 2007 survey, clopidogrel is the sixth most commonly dispensed medication in the USA.
•To reduce the risk for gastrointestinal bleeding, clinicians often prescribe a concomitant proton-pump inhibitor (PPI)
for high-risk patients .
•Recent evidence suggests that certain PPIs reduce the antiplatelet effects of clopidogrel .
•Clopidogrel, a prodrug, requires metabolism in the liver via cytochrome P450 (CYP) enzymes .
PPIs reduces the antiplatelt effects of clopidogrel: Proposed mechanism
•Once activated, clopidogrel blocks platelet aggregation by inhibiting adenosine diphosphate at the P2Y12 receptor .
•PPIs, such as omeprazole and its S-enantiomer esomeprazole (Nexium®), are thought to inhibit the CYP2C19 enzyme, thus negating the antithrombotic
effects of clopidogrel.
•CYP2C19 also acts as the primary enzyme responsible for determining a patient’s pharmacodynamic response to
clopidogrel.
PPIs reduces the antiplatelt effects of clopidogrel:
145 patients undergoing PCI and receiving Aspirin, 75 mg daily, and clopidogrel, 75 mg
daily (after a 300-mg loading dose).
Pre-treatment: the PRI was 83.2% in the control group and 83.9% in the treatment group .
Post-treatment: the PRI was 39.8% in the control group and 51.4% in the
treatment group (P < .001) .
The long-term implications of this interaction are uncertain but may suggest reduced cardioprotective benefits of clopidogrel .