Pharmacodynamic Impacts of Proton Pump Inhibitors on the Efficacy of Clopidogrel In Vivo-A Systematic Review
| Autor: | Tian-cheng Luo, Shiyao Chen, Xiao-Qing Zeng, Jingjing Lian, Jie Chen |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Acute coronary syndrome
medicine.medical_specialty business.industry General Medicine Odds ratio Cochrane Library medicine.disease Clopidogrel Surgery law.invention P2Y12 Randomized controlled trial law Internal medicine Meta-analysis Pharmacodynamics medicine Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Clinical Cardiology. 36:184-189 |
| ISSN: | 0160-9289 |
| Popis: | Background There is considerable debate about whether concomitant use of proton pump inhibitors (PPIs) should be recommended for patients who are prescribed clopidogrel after acute coronary syndrome. Most pharmacokinetic and pharmacodynamic studies in vivo were conducted using small sample sizes and were single centered, resulting in conflicting data. Hypothesis PPIs may attenuate the antiplatelet effect of clopidogrel in vivo and lead to an increased risk of cardiovascular events. Methods PubMed, the Cochrane Library, Embase, Web of Science, and China Biology Medicine Disc were searched. Randomized controlled trials that compared pharmacodynamic impacts of a PPI on the efficacy of clopidogrel in vivo were included. Two independent reviewers evaluated study quality and extracted data for meta-analysis. Results We identified 8 eligible studies. Compared to clopidogrel treatment alone, patients who received both a PPI and clopidogrel had less of a decrease in the platelet reactivity index (weighted mean difference [WMD]: 8.18; 95% confidence interval [CI]: 6.81–9.56; P < 0.00001), less adenosine 5′-diphosphate–induced platelet aggregation inhibition (WMD: 7.28; 95% CI: 2.44–12.11; P = 0.003), higher P2Y12 reaction units (WMD: 40.58; 95% CI: 19.31–61.86; P = 0.0002), and higher risks of clopidogrel resistance (odds ratio [OR]: 2.49; 95% CI: 1.49–4.14; P = 0.0005). There were no significant differences, however, for the incidences of major adverse cardiovascular events between the 2 groups (OR: 1.07; 95% CI: 0.44–2.59; P = 0.88), and treatment with a PPI and clopidogrel significantly reduced the risk of adverse gastrointestinal events (OR: 0.16; 95% CI: 0.04–0.62; P = 0.008). Conclusions Concomitant use of a PPI with clopidogrel attenuated the antiplatelet effect of clopidogrel, but may be clinically unimportant because there were no clinical differences in the risk for major adverse cardiovascular events. Additional Supporting Information may be found in the online version of this article. The authors have no funding, financial relationships, or conflicts of interest to disclose. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|