Impact of proton pump inhibitors or famotidine on the antiplatelet actions during dual-antiplatelet therapy in Japanese
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ORIGINAL ARTICLE
Impact of proton pump inhibitors or famotidine on the antiplatelet actions during dual-antiplatelet therapy in Japanese patients Yoshiki Nagata • Jyun-ichiro Inomata • Masaki Kinoshita • Keisuke Kurokawa • Isao Aburadani • Michiro Maruyama • Kazuo Usuda
Received: 22 February 2012 / Accepted: 24 July 2012 / Published online: 11 August 2012 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2012
Abstract Background It has been reported that the antiplatelet action becomes attenuated when a proton pump inhibitor is used in combination with clopidogrel. Purpose: The effect of an antacid causing platelet aggregation during the administration of clopidogrel was investigated. Subjects and methods The subjects consisted of 265 patients with coronary artery disease. Platelet aggregation function testing (light transmittance aggregometry) was conducted while aspirin and clopidogrel 75 mg were taken orally and the minimum concentration of aggregation induction platelet aggregation threshold index was measured. The ADP-PATI, measured with ADP as the inducing substance, was compared and investigated according to the type of concomitantly used antacid. Result The results of the ADP-PATI were: control group: 3.47 ± 0.95 lM (N = 67), famotidine group: 3.80 ± 0.52 lM (N = 32), rabeprazole group: 3.43 ± 0.93 lM (N = 87), lansoprazole group: 3.28 ± 1.04 lM (N = 63) and omeprazole group: 3.33 ± 0.81 lM (N = 16). No statistically significant difference was observed regarding the ADPPATI of respective groups compared to the control group. Conclusion The concomitant use of famotidine, rabeprazole, lansoprazole, and omeprazole did not affect the antiplatelet action of clopidogrel in Japanese patients. Keywords Clopidogrel Proton pump inhibitor Famotidine Platelet aggregation function test
Y. Nagata (&) J. Inomata M. Kinoshita K. Kurokawa I. Aburadani M. Maruyama K. Usuda Division of Cardiology, Department of Internal Medicine, Toyama Prefectural Central Hospital, Nishinagae 2-2-78, Toyama-shi, Toyama 930-8550, Japan e-mail: [email protected]
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Background Antiplatelet therapy is the most important drug therapy in the treatment of coronary artery disease. In particular, with patients undergoing drug-eluting stent (DES) implantation, it is recommended to continue dual-antiplatelet therapy (DAPT) with low-dose aspirin and clopidogrel over a long period of time [1, 2]. Complications have been reported such as a peptic ulcer which frequently occurs in patients taking low-dose aspirin over a long period of time. Other Complications included increased frequency of complicated serious gastrointestinal bleeding when clopidogrel was concomitantly used [3, 4]. Concomitant use with an H2-receptor antagonist or proton pump inhibitor (PPI) is recommended as a preventive drug against gastrointestinal bleeding and/or peptic ulcer [2, 5]. In 2009, it was reported that when clopidogrel and PPIs (in particular, omeprazole) were concomitantly used following myocardial infarction, the risk of hea
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