Clinical Study of Effect of Proton Pump Inhibitors on Efficacy of Clopidogrel in Patients with Acute Coronary Syndromes

Clinical Study of Effect of Proton Pump Inhibitors on Efficacy of Clopidogrel in Patients with Acute Coronary Syndromes   Parag Patel*, Ravi Raval, Dr. J. B. Dave, Dr. I. S. Anand Department of Clinical Pharmacy Shri Sarvajanik Pharmacy College, Affiliated to Gujarat Technological University, Nr Arvind baug, Mehsana, Gujarat, India E-mail Id: paragpatel12231@gmail.com

Abstract

Purpose:  The objectives for this study were to evaluate the significance of this interaction on clinical efficacy of clopidogrel and also to make comparative assessment among different PPIs used with clopidogrel.

Methods:  Comparison of clopidogrel efficacy and rate of Major Adverse Cardiac Events (MACE) was carried out in patient with Acute Coronary Syndrome (ACS) treated at Life Care Hospital’s Ahmedabad. Patients taking Colpidogrel with PPI (n=39) were compared against patients taking clopidogrel alone (n=36). They were observed for platelet aggregation function by light transmission agreegometry and incidence of MACE like rehospitalisation, reinfarction, restenosis, stroke and death. The results were compared for their significances using ANOVA and chi-square analysis. 

Results:  Inhibition of platelet aggregation was found significantly reduced in patient taking concomitant PPI compared to patients taking clopidogrel alone (Mean % IPA 16.04 ± 1.99 % Vs 23.79 ± 1.83 %, p value < 0.05). Mean % IPA was found significantly reduced in patient taking Omeprazole (13.68 %) as compared to Pantoprazole (16.78 %) and Rabeprazole (17.18 %). Incidence of MACE was also found more in patient taking concomitant PPIs. 

Conclusion:  Concomitant use of PPIs led to inhibition of antiplatelet effect and clinical efficacy of Clopidogrel. Omeprazole is more prone to interact with clopidogrel compared to other PPIs. It could not be conclusively established whether this interaction could lead to increase in MACE.