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Drug Interaction Between Clopidogrel and Ranitidine or Omeprazole in Stable Coronary Artery Disease: A Double-Blind, Double Dummy, Randomized Study.
- Source :
-
American Journal of Cardiovascular Drugs . Aug2016, Vol. 16 Issue 4, p275-284. 10p. - Publication Year :
- 2016
-
Abstract
- Background: Proton-pump inhibitors (PPIs) are often prescribed to patients receiving dual antiplatelet therapy (DAPT). However, this class of medication, especially omeprazole, has been associated with a reduction in clopidogrel efficacy, leading many clinicians to substitute omeprazole with ranitidine. Objectives: Our objective was to compare the antiplatelet effect of clopidogrel before and after the addition of omeprazole or ranitidine. Methods: We measured platelet aggregability at baseline and after 1 week of clopidogrel 75 mg daily. Subjects were then randomized in a double-blinded, double-dummy fashion to omeprazole 20 mg twice daily (bid) or ranitidine 150 mg bid. We repeated aggregability tests after 1 additional week, using VerifyNow P2Y12™ (Accumetrics; San Diego, CA, USA), depicting aggregability as percent inhibition of platelet aggregation (IPA). Results: We enrolled 41 patients in the omeprazole group and 44 in the ranitidine group. IPA was significantly decreased after the addition of omeprazole to clopidogrel (from 26.3 ± 32.9 to 17.4 ± 33.1 %; p = 0.025), with no statistical significant changes observed in the ranitidine group (from 32.6 ± 28.9 to 30.1 ± 31.3 %; p = 0.310). The comparison of IPA in both groups at the end of the follow-up showed a trend toward significance ( p = 0.07, 95 % confidence interval [CI] −1.19 to 26.59); after excluding homozygous patients for 2C19*2 genotype, the comparison of IPA between the groups reached statistical significance (32.7 ± 30.8 vs. 17.7 ± 33.4 %, respectively, for ranitidine and omeprazole groups; p = 0.04). Conclusions: Unlike omeprazole, ranitidine did not influence platelet aggregability response to clopidogrel. Clinical Trial Registration: NCT01896557. [ABSTRACT FROM AUTHOR]
- Subjects :
- *ANALYSIS of variance
*BLOOD coagulation tests
*BLOOD platelet aggregation
*COMBINATION drug therapy
*CHI-squared test
*CONFIDENCE intervals
*DRUG interactions
*FACTOR analysis
*FISHER exact test
*LONGITUDINAL method
*OMEPRAZOLE
*POLYMERASE chain reaction
*PROBABILITY theory
*RANITIDINE
*STATISTICS
*T-test (Statistics)
*COMORBIDITY
*DATA analysis
*STATISTICAL significance
*RANDOMIZED controlled trials
*REPEATED measures design
*BLIND experiment
*CLOPIDOGREL
*DATA analysis software
*DESCRIPTIVE statistics
*MANN Whitney U Test
*GENOTYPES
*PHARMACODYNAMICS
Subjects
Details
- Language :
- English
- ISSN :
- 11753277
- Volume :
- 16
- Issue :
- 4
- Database :
- Academic Search Index
- Journal :
- American Journal of Cardiovascular Drugs
- Publication Type :
- Academic Journal
- Accession number :
- 117355612
- Full Text :
- https://doi.org/10.1007/s40256-016-0172-5