Effect of different proton pump inhibitors on antiplatelet efficacy of clopidogrel in patients with non-ST segment elevation acute coronary syndrome

Abstract

Objective The study sought to compare the effect of different proton pump inhibitors (PPI) on antiplatelet efficacy of clopidogrel in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Methods A prospective, randomized clinical trial was studied. One hundred and forty-five patients with NSTEACS after drug eluting stent implantation were recruited in the study. Patients were assigned into group A and B randomly, and given standard medical therapy (clopidogrel, aspirin, low molecular weight heparin, nitrates, statins and other routine treatments). Patients in group A (n=72) were treated with pantoprazole, while with omeprazole in group B (n=73). We examined the one-year incidences of gastrointestinal bleedings and major adverse cardiac events(MACE) including all cause mortality, cardiovascular death, stroke, hospitalization due to angina pectoris or heart failure, and revascularization. Results The rates of cardiovascular events between group A and B was of no significant difference (P>0.05): all cause mortality (6.9% vs. 5.5%); cardiovascular death (4.2% vs. 5.5%); hospitalization due to angina pectoris or heart failure (16.6% vs. 15.0%); revascularization (11.1% vs. 12.3% ). There was no significant difference between the two groups in gastrointestinal bleeding (5.6% vs. 5.5%, P>0.05). Conclusions The effect of two major kinds of PPI on antiplatelet efficacy of clopidogrel has no significantly different in patients with NSTEACS. Key words: Proton pump inhibitors; Platelet aggregation inhibitors; Acute coronary syndrome; Clopidogrel