| Objective: Acute coronary syndrome includes unstable angina, ST or non-ST segment elevation myocardial infarction. Acute coronary syndrome is a group of acute clinical syndrome, whose pathology foundation is based on coronary atherosclerotic plaque rupture, and secondary complete or incomplete occlusive thrombosis. The activation of blood platelet plays a key role in the development of acute coronary syndrome, so the important status of antiplatelet therapy on the prevention and treatment of acute coronary syndrome is being paid more and more attention. Platelet plays an influential role in the formation of atheromatous plaque, and the thrombosis following plaque rapture. As a new generation of platelet aggregation inhibitor, clopidogrel is currently used as the antiplatelet drug in the prevention and treatment of atherosclerosis ischemic disease. There are increasing numbers of clinical trials to prove that aspirin and clopidogrel dual therapy can decrease the prevalence of cardio vascular events like acute coronary syndrome in high risk patients, as well as the incidence of ischemic events in patients ready for percutaneous coronary intervention. However, the use of antiplatelet agents frequently leads to gastrointestinal injury or increases the risk of gastrointestinal bleeding. To prevent gastrointestinal injury, proton pump inhibitors have been used widely in clinical practice. But recent studies show that treatment with clopidogrel plus proton pump inhibitors can increase the incidence of adverse cardiovascular events. As they shared the same metabolic pathway in the liver,some data indicated that the concomitant use of clopidogrel and proton pump inhibitors may attenuate the benefits of antiplatelet effects probably outcoming with an increase risk of cardiovascular events.This trial sought to assess the influence of proton pump inhibitor on clopidogrel efficacy of the patient who received dual antiplatelet therapy.Subjects: A total of 90 patients (60 male and 30 female, mean age were 25.20±1.10 years old) who were diagnosed as coronary heart disease in the second hospital of Hebei medical university were enrolled between September 2009 and October 2010, including 74 patients with unstable angina, 12 with ST-segment elevation myocardial infarction and 4 with Non-ST-segment elevation myocardial infarction. The criteria for exclusion include as the followings:①family history or Individual bleeding disorder;②platelet count <150×10~9/L or >450×10~9/L;③complicating of immune system diseases, neoplasms, endocrine and hematopoietic system diseases, peripheral vascular disease;④previous treatment with clopidogrel or PPI;⑤receiving the therapy of antagonist of platelet (warfarin or heparin) and clopidogrel within one month;⑥gastrointestinal ulcer or operation history with in 6 months, or pregnancy.Methods: All patients were randomly divided into 3 groups, placebo group, omeprazole group (receiving omeprazole 20 mg/day) or esomepra- le group (receiving esomeprazole 20 mg/day), with 30 patients in each group. All the patients received clopidogrel (loading dose, followed by 75 mg/day) and aspirin (100 mg/day). Blood samples were obtained at the day before clopidogrel therapy and 5-7 days after clopidogrel therapy. Platelet aggregation was measured with whole blood impedance method induced by adenosine diphosphate (ADP) at 10μmol/L with a mobile four-channel impedance aggregometer (Chronolog-Log Corporation), which allowed measurement of aggregation beginning 1 hour after blood sampling.Statistical analysis: All statistical analysis was performed using SPSS 17.0 software. Continuous variables were expressed as the mean value and standard deviation. Categorical variables were summarized as frequency and compared using chi-square test. The comparison of quantitative variables between three groups was performed with variance analysis. The multiple comparison was performed with student-newman- keuls. The comparison of determination values before and after administration was evaluated by paired-samples t test. Statistical significance was defined as P < 0.05.Results: The platelet aggregation had no significant difference before administration (P > 0.05), which was obviously decreased at 5-7 days after administration (P < 0.05). However, the Platelet aggregation differences between the control group, omeprazole group and esomeprazole group had no significant (P > 0.05).Conclusions: In the patients of ACS who received dual antiplatelet therapy, the intake of standard dose of omeprazole or esomeprazole is not associated with impaired response to clopidogrel in a short time.
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