Combination Of Clopidogrel Research Articles

Desaggregant Therapy of Patients With Ischemic Heart Disease: Unsolved Problems

At present, choice of antiplatelet therapy in ischemic heart disease (IHD) patients depends on the IHD form, accepted treatment guidelines, contraindications, and cost of drugs. Usually, there is no regular control of the action of antiplatelet drugs. However, in many patients such therapy does not improve the long-term outcome. Increasing dosage of antiaggregants has no positive effect on prognosis. Presently attempts have been made to improve survival by introduction of double or triple drug combinations. Furthermore, although long-term treatment with combination of aspirin and clopidogrel, or both drugs plus one of the new oral anticoagulants (thrombin or a factor inhibitors) has no significant positive effect on total mortality, such therapy significantly increases risk of massive internal and particularly intracranial bleeding. In view of small decreasing effect of such therapy on the rate of reinfarction and stroke, one should search for new approaches. One of such approaches is selection of an antiplatelet drug taking into consideration its effect on the aggregative reactivity of platelets. There are considerable data proving that high residual platelet reactivity (RPR) during antiplatelet therapy is associated with elevated risk of diseases caused by arterial thrombosis. Our research demonstrates that one can overcome high RPR by substituting clopidogrel for aspirin and vice versa or by using combination of these drugs. Indeed, in patients with high RPR during aspirin or clopidogrel monotherapy this combination is associated only with slight increase of number of patients with target level of platelet reactivity. It can be supposed that in this group of patients one of oral anticoagulants (e.g. rivaroxaban) should be used in combination with clopidogrel.

Changes in Practice Patterns of Clopidogrel in Combination with Proton Pump Inhibitors after an FDA Safety Communication.

ObjectivesIn 2009, the FDA issued a warning that omeprazole–a proton pump inhibitor (PPI)–reduces the antithrombotic effect of clopidogrel by almost half when taken concomitantly. This study aims to analyze the impact of the FDA Safety Communications on prescribing clopidogrel together with PPIs.MethodsThis retrospective study identified clopidogrel users from the Truven Health Analytics MarketScan Databases (01/2006–12/2012). Rates of clopidogrel-PPI combination therapy were estimated in 6-month intervals for patients with ≥1 clopidogrel prescription fill, then were analyzed pre- and post-safety communication (11/17/2009). Analyses were also conducted by grouping PPIs into CYP2C19 inhibitors (omeprazole and esomeprazole) and CYP2C19 non-inhibitors (pantoprazole, lansoprazole, dexlansoprazole, and rabeprazole).ResultsOverall, 483,074 patients met the selection criteria; of these, 157,248 used a clopidogrel-PPI combination. On average, 30.5% of patients in the pre- and 19.9% in the post-communication period used a clopidogrel-PPI combination therapy. Among clopidogrel users, the probability of using clopidogrel-PPI combinations fell by over 40% in the post-communication period (OR = 0.57; p<0.001); the proportion of patients using esomeprazole fell from 12.9% to 5.3%, and the proportion using omeprazole fell from 10.1% to 6.3%. Among combination therapy users, the probability of patients using a combination with a CYP2C19 inhibitor decreased by 53% (OR = 0.47; p<0.001); however, 31.5% of patients were still prescribed a clopidogrel-PPI combination therapy. Trends were similar for all and newly treated patients, regardless of clopidogrel indication and physician specialty.ConclusionsThe FDA Safety Communication resulted in a reduction in the number of patients undergoing combination therapy; however approximately one-third of patients still used combination therapy post-communication.

Prescription pattern in indoor patients of cardiovascular diseases: a descriptive study in a tertiary care hospital attached to a government medical college

Background: In India, one of the leading causes of death is cardiovascular diseases (CVDs). The study of prescription pattern ensures rational pharmacotherapy and assures quality medical care to the patients. Hence the present study was conducted to observe the prescription pattern of drugs among the indoor patients of cardiovascular diseases in a tertiary care hospital attached to a Government Medical college. Methods: A retrospective observational study of 9 month duration was undertaken from January- September 2015. A total number of 113 indoor cardiovascular disease patients’ case sheets were utilized for our study from medicine and ICCU department of a tertiary care hospital. The data was analysed and the results were expressed as counts and percentage. Results: Of 113 patients, most of the patients were of the age group of 56-65 years (40.71%). The prevalence of CVDs was higher in females (56.64%) than males (43.36%). Hypertension (58.41%) and Ischemic heart disease (41.59%) were found to be predominant CVDs. Nifedipine (53.10%), Atenolol (31.86%), Isosorbide dinitrate (40.71%), Atorvastatin (53.10%) were the most commonly prescribed cardiovascular drugs. Aspirin and Clopidogrel combination was prescribed in 46.90% of CVD patients. The average number of drugs per prescription was 6.53. Conclusions: The present study shows that most of drugs were prescribed rationally according to the current treatment guidelines except the under use of ACEIs and ARBs in hypertensive diabetes mellitus patients. Standard treatment guidelines should be circulated among practicing physicians to encourage rational prescription.

Antithrombotic Therapy.

Symptomatic cerebral atherosclerosis including intracranial atherosclerosis (ICAS) is associated with a high risk of recurrent stroke. Antithrombotic agents are the mainstay of therapy in these patients. Several studies have found anticoagulation (warfarin) to increase the risk of bleeding events and have an efficacy no better than that of aspirin. Therefore, anticoagulants are not widely used unless patients develop recurrent ischemic symptoms despite receiving antiplatelet therapy. Because ICAS progression is not uncommon and the risk of stroke recurrence is high when aspirin monotherapy is used, dual antiplatelet agents may be needed at least in the early disease stage. The Trial of Cilostazol in Symptomatic Intracranial Stenosis (TOSS) found that aspirin plus cilostazol was significantly better than aspirin monotherapy in preventing progression (6.7 vs. 28.8%, p = 0.008). The TOSS II trial that compared aspirin plus cilostazol with aspirin plus clopidogrel found no significant difference in the progression rate (9.3% vs. 15.5%, p = 0.092). However, the overall changes in stenosis were more favorable (i.e., less progression and more regression) in the cilostazol group (p = 0.049). TOSS studies have limitations in that the end points were changes in magnetic resonance angiography results rather than clinical outcomes. Based on the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial results, and the fair outcome found in patients enrolled in the SAMMPRIS (Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis) trial, aspirin plus clopidogrel has been recommended in the early stage of symptomatic ICAS. However, the combination of aspirin and clopidogrel did not show superiority over aspirin monotherapy in ICAS patients in a recent CHANCE substudy. Considering that ICAS is the major pathology leading to stroke worldwide, further studies are needed to identify the best medication strategy in ICAS patients. Until then, physicians may choose appropriate antiplatelet agents after careful consideration of the characteristics of both the patients (i.e., degree of stenosis, stroke mechanism, risk of stroke, and risk of bleeding) and the antiplatelet agent (e.g., side effect, cost).

Dual Antiplatelet Therapy in Patients with Stable Ischemic Heart Disease.

Dual antiplatelet therapy (DAPT) is the use of a P2Y12 receptor antagonist (clopidogrel, prasugrel, or ticagrelor) in combination with aspirin. Recommendations for its use are primarily in patients who have experienced acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) in the preceding 12 months. There is a growing body of evidence, however, investigating the use of long-duration DAPT in patients with stable ischemic heart disease (SIHD). SIHD is defined as clinical evidence of ischemic heart disease, without an ACS event in the preceding 12 months, and includes patients with stable angina, elective PCI, and remote history of ACS. The use of DAPT in the SIHD population and the recent advancements in our understanding of its use are the focus of this review.

High residual platelet reactivity (HRPR) for adenosine diphosphate (ADP) stimuli is a determinant factor for long-term outcomes in acute ischemic stroke with anti-platelet agents: The meaning of HRPR after ADP might be more prominent in large atherosclerotic infarction than other subtypes of AIS.

High residual platelet activation (HRPA) after ADP stimuli has associated with recurrent vascular events in acute atherothrombosis with the use of antiplatelet agents (APAs). However, there has been little evidence supporting this association in acute ischemic stroke (AIS). In this study, we evaluated the influences of HRPR after ADP stimuli on the 1-year incidence of recurrent cardiovascular events and mortality in AIS with APAs. We conducted an observational, referral center cohort study on 968 AIS patients with APAs from January 2010 to December 2013 who were evaluated using optical platelet aggregometry (OPA). All patients received the dual APA combination of aspirin and clopidogrel or aspirin alone. We evaluated their platelet function 5days after hospital admission using OPA. HRPR after ADP stimuli was defined as platelet aggregation of 70% or greater according to OPA after 10µM ADP stimuli. The primary endpoint was a composite of all causes of death, myocardial infarction, and stroke at the 1-year follow-up. The secondary endpoints were each component of the primary endpoint. The event rate of primary endpoint was 11.3% (109/968). Its rate was significantly higher in the patients with HRPR (16.7%) than in those without (9.7%). HPRP was independently associated with the primary endpoint (OR=1.97, CI 1.22-3.18, p<0.01). According to the AIS subtype, the presence of HRPR was independently significant for the occurrence of the primary endpoint in the large artery atherosclerosis (LAA) subtype only (OR=2.26, CI 1.15-4.45, p=0.02). In this study, the presence of HRPR after ADP stimuli is associated with a poor long-term outcome after acute ischemic stroke. In particular, the influence of this factor might be more prominent in LAA compared with other types of AIS.

Abstract 15108: Outcomes in Patients With Pericardial Effusion Requiring Drainage After Electrophysiology Procedures

Background: Pericardial effusion (PE) is a known complication of electrophysiological procedures (EPP). We sought to describe patient characteristics and outcomes in PE requiring drainage after EPP. Methods: We identified 114 patients who underwent EPP at our center from 2000 to 2012 and had an intervention for new pericardial effusion up to 1 month after the EPP. Baseline demographic and clinical data were recorded. Primary outcome was 30 days mortality after PE drainage. Secondary outcome was major bleeding (drop in hemoglobin ≥ 3 gm/dl or requiring blood transfusion) after PE drainage. Results: Mean age was 65±13 years (48% men). Mean ejection fraction (EF) was 53±12. Hypertension and diabetes mellitus were found in 54 and 49%. Heart failure (HF) and coronary artery disease were present in 26 and 27%. Dual antiplatelet therapy was used in 6.7%, while combined Aspirin, Clopidogrel and oral anticoagulant was used in 1.7%. Intra-procedural heparin was used in 62%. Presenting symptoms were chest pain, shortness of breath and altered mental status in 51, 42 and 26%. Pulmonary vein isolation was done in 50% while pacemaker insertion and ventricular tachycardia ablation were done in 8.8 and 9.7%. Drainage of PE was done by emergent and elective pericardiocentesis in 65 and 28% while elective pericardial window and emergent sternotomy for exploration was done in 2.6 and 4.4%. Re-accumulation occurred in 12.3% and a second intervention was required in 57% of those patients. The primary outcome occurred in 2.6% and secondary outcome occurred in 45.6%. Predictors of mortality were older age, higher drop in hemoglobin, and lower EF (all p&lt;0.05). Predictors of secondary outcome were HF and higher INR at time of procedure (both p=&lt;0.05). Conclusion: Pericardial effusion after an electrophysiology procedures requiring intervention is associated with a mortality of 2.6% within 30 days. Older age, lower ejection fraction and higher drop in hemoglobin were associated with worse outcomes.

Diabetes mellitus and clopidogrel “resistance”

In our Department arrives a 75-year-old patient with hypertension, diabetes mellitus (DM) treated with hypoglycaemic drugs, dyslipidaemia and ischaemic heart disease post-acute myocardial infarction treated with triple coronary artery bypass surgery and subsequent percutaneous transluminal coronary angioplasty (PTCA). After a new PTCA and positioning of medical stent he is discharged with a double antiplatelet therapy. But after one month two thrombotic events occur in this patients almost simultaneously. Antiplatelet therapy such as clopidogrel and aspirin in combination, is the current gold standard for reducing cardiovascular events in patients with DM, providing a synergistic platelet inhibition through different platelet activation pathways, but platelets of DM patients are characterised by disregulation of several signalling pathways which may play a role not only in the higher risk of developing cardiovascular events and the worse outcome, but also in the larger proportion of DM patients with inadequate response to antiplatelet drugs compared to non DM subjects.

Comparative effect on platelet function of a fixed-dose aspirin and clopidogrel combination versus separate formulations in patients with coronary artery disease: A phase IV, multicenter, prospective, 4-week non-inferiority trial

Background/objectivesThe effect of aspirin and clopidogrel in a fixed-dose combination (FDC) on platelet function was compared with separate formulations in patients that had undergone percutaneous coronary intervention (PCI) with drug-eluting stent (DES). MethodsThis was a phase IV, prospective, multicenter, single-arm, non-inferiority study. Patients that had taken aspirin 100mg and clopidogrel 75mg once daily as separate formulations for >6months after PCI with DES were enrolled, and then switched to an aspirin/clopidogrel FDC once-daily for 4weeks. Platelet reactivity was determined using the VerifyNow® P2Y12 assay at baseline (immediately prior to switching) and 4weeks later. ResultsA total of 648 patients (the full-analysis population; age, 63.6±9.0years; male, 76.5%) finished the study, and 565 (the per-protocol population) completed without protocol violations. In the per-protocol population, the % inhibitions of P2Y12 and ARU were not significantly different between baseline and after 4weeks of FDC treatment (29.2±20.0% to 29.0±19.9%, P=0.708; 445.1±69.2 to 446.2±63.0, P=0.799, respectively) and the difference in P2Y12 inhibition observed did not exceed the predetermined limit of non-inferiority (95% CI, −0.9 to 1.3). In the full-analysis population, the % inhibitions of P2Y12, PRU, and ARU were not significantly changed after 4weeks of FDC treatment. ConclusionsThis study demonstrates that the efficacy of platelet inhibition by an aspirin/clopidogrel FDC was not inferior to that of separate aspirin and clopidogrel formulations in patients that had undergone PCI with DES.

Oral Prostacycline Analog and Clopidogrel Combination provides Early Maturation and Long-term Survival after Arteriovenous Fistula Creation: A Randomized Controlled Study

Oral Prostacycline Analog and Clopidogrel Combination provides Early Maturation and Long-term Survival after Arteriovenous Fistula Creation: A Randomized Controlled Study

Antithrombotic therapy in the anticoagulated patient undergoing percutaneous coronary intervention with coronary stenting

Despite being the subject of extensive research, the optimal antithrombotic therapy for patients on chronic oral anticoagulation (OAC) undergoing percutaneous coronary intervention (PCI) with stent implantation is still unknown. This review presents the latest data regarding this much-debated topic. Dual therapy, with clopidogrel (a P2Y12 inhibitor) and OAC, may be an alternative to triple therapy, which usually consists of aspirin and clopidogrel in addition to OAC, in terms of improving clinical outcomes in patients on chronic OAC following PCI with stent implantation. With the arrival of new, safer nonvitamin K antagonists oral anticoagulants (NOACs), the combination of NOAC and clopidogrel may also be an option for replacing triple therapy. In contrast to clopidogrel, combining the more potent P2Y12 inhibitors (prasugrel and ticagrelor) with OAC may only be considered in certain specific circumstances. Patients on chronic OAC undergoing PCI with stent implantation require triple therapy. However, triple therapy is controversial, because it increases the risk of bleeding. With the introduction of prasugrel, ticagrelor and NOACs, the question arises which P2Y12 inhibitor to choose as part of the triple therapy regime and how NOACs combine with antiplatelet agents when treating patients undergoing PCI.

Prediction of high risk of non-adherence to antiplatelet treatment.

Dual antiplatelet therapy with acetylsalicylic acid (ASA) and clopidogrel is the standard of care for secondary prevention. Premature discontinuation of clopidogrel is associated with an increased risk of myocardial infarction (MI) or death, and greater health care expenditure. To develop an objective method for identification of patients with high risk of non-adherence to clopidogrel after MI. A total of 189 patients were enrolled into a prospective, observational, single-centre study with a nine-month follow-up. Patients received a 600-mg loading dose and 75-mg maintenance dose of clopidogrel in combination with ASA doses of 300 mg and 75 mg, respectively. Adenosine diposphate-induced platelet aggregation (ADP-PA) was assessed during baseline hospitalisation and at three, six, and nine months after discharge. Adherence to medication with clopidogrel was defined as the proportion of drug availability based on data from the National Health Fund regarding prescribed drug purchases. Adherence was arbitrarily judged adequate when the proportion exceeded 80%. According to our hypothesis, ADP-PA in non-adherent patients should be higher at follow-up visits (at least once) as compared with measurement at hospitalisation. Based on the ROC curve analysis, the optimal cut-off point equal to 4 U was defined (p < 0.0001, 95% CI 0.562-0.654; sensitivity: 60.6%, specificity: 57.1%, positive predictive value: 63.3%, negative predictive value: 54.2%). The prevalence of true adherence to medication in groups of high and low probability of adherence defined according to developed criteria amounted 60 (50.8%) and 23 (32.4%) cases, respectively (p = 0.01). The newly developed method of objective identification of patients with high risk of non-adherence to clopidogrel after MI is easily applicable and cheap, and, despite relatively low sensitivity and specificity, it efficiently differentiates patients with regard to clinical end-points during follow-up.

Safety and efficacy of intensive vs. guideline antiplatelet therapy in high-risk patients with recent ischemic stroke or transient ischemic attack: rationale and design of the Triple Antiplatelets for Reducing Dependency after Ischaemic Stroke (TARDIS) trial (ISRCTN47823388).

RationaleThe risk of recurrence following a stroke or transient ischemic attack is high, especially immediately after the event.HypothesisBecause two antiplatelet agents are superior to one in patients with non‐cardioembolic events, more intensive treatment might be even more effective.Sample size estimatesThe sample size of 4100 patients will allow a shift to less recurrence, and less severe recurrence, to be detected (odds ratio 0·68) with 90% power at 5% significance.Methods and design Triple Antiplatelets for Reducing Dependency after Ischaemic Stroke (ISRCTN47823388) is comparing the safety and efficacy of intensive (combined aspirin, clopidogrel, and dipyridamole) vs. guideline antiplatelet therapy, both given for one‐month. This international collaborative parallel‐group prospective randomized open‐label blinded‐end‐point phase III trial plans to recruit 4100 patients with acute ischemic stroke or transient ischemic attack. Randomization and data collection are performed over a secure Internet site with real‐time data validation and concealment of allocation. Outcomes, serious adverse events, and neuroimaging are adjudicated centrally with blinding to treatment allocation.Study outcomeThe primary outcome is stroke recurrence and its severity (‘ordinal recurrence’ based on modified Rankin Scale) at 90 days, with masked assessment centrally by telephone. Secondary outcomes include vascular events, functional measures (disability, mood, cognition, quality of life), and safety (bleeding, death, serious adverse events).DiscussionThe trial has recruited more than 50% of its target sample size (latest number: 2399) and is running in 104 sites in 4 countries. One‐third of patients presented with a transient ischemic attack.

Incidence of cardiovascular events and gastrointestinal bleeding in patients receiving clopidogrel with and without proton pump inhibitors: an updated meta-analysis

BackgroundDual antiplatelet therapy is the standard of care after coronary stent placement but increases the bleeding risk. The effects of proton pump inhibitors (PPIs) on clopidogrel metabolism have been described,...

Clopidogrel with aspirin versus aspirin alone in prevention of stroke following transient ischemic attack or acute minor stroke.

Clinical question Following transient ischemic attack or acute minor stroke, does the combination of clopidogrel and aspirin reduce the risk of stroke greater than aspirin alone? Article chosen Wang Y, Wang Y, Zhao X, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013;369:11-9. The primary outcome measured in this study was ischemic or hemorrhagic stroke at 90 days of follow-up in groups assigned to treatment with a combination of aspirin and clopidogrel or aspirin alone following transient ischemic attack or acute minor stroke. The secondary outcomes were new clinical vascular events, including vascular death.

Unfractionated heparin–clopidogrel combination in ST-elevation myocardial infarction not receiving reperfusion therapy

ObjectiveWe sought explore the relative benefits of unfractionated heparin (UFH) compared with enoxaparin, alone or in combination with clopidogrel, in ST-segment elevation myocardial infarction (STEMI) patients not undergoing reperfusion therapy. MethodsThis is a propensity score study from The International Survey on Acute Coronary Syndromes in Transition Countries (ISACS-TC/NCT01218776) on patients admitted between October 2010–June 2013. There were a total of 1175 STEMI patients who did not receive mechanical or pharmacological reperfusion. Of these, 1063 were eligible for the aim of the study, being treated with UFH (522/1175; 44.4%) or enoxaparin (541/1175; 46%). Clopidogrel in combination with UFH or enoxaparin was given to 751 (63.9%) patients. The primary endpoint was in-hospital mortality. Secondary endpoints were intracranial hemorrhages, and clinically relevant bleedings. ResultsAfter adjustment for any confounders, UFH was associated with a lower risk of in-hospital mortality in clopidogrel users (multivariate adjusted regression analysis: odds ratio [OR]: 0.62, 95% Confidence Interval [CI] 0.41–0.94) as compared with clopidogrel non-users (OR: 0.94, 95% CI 0.55–1.60). The observed effect was not associated with combined enoxaparin and clopidogrel therapy. Major bleeding events were comparable in the enoxaparin group and UFH group (0.4% and 1.5% respectively, p = 0.06). The risk of major hemorrhage was nearly similar with combined UFH-clopidogrel therapy (1.4%) as compared with UFH alone (1.9%), p = 0.67. ConclusionUFH – Clopidogrel combination was associated with a large mortality reduction in STEMI patients not undergoing reperfusion therapy and did not significantly increase the risk of major bleeding.

Clopidogrel is not associated with increased bleeding complications after full-mouth extraction: A retrospective study

BackgroundTo the authors' knowledge, the effect of clopidogrel on bleeding complications during full-mouth extraction has not been studied. The authors aimed to determine the safety of continued use of clopidogrel during full-mouth extraction. MethodsThe authors performed a retrospective study of consecutive patients undergoing full-mouth extraction who were taking aspirin, clopidogrel, a combination of aspirin and clopidogrel, or neither. The main study outcomes in the 4 study groups were estimated blood loss, transfusion requirements, and complications. The authors also examined the correlation between the number of teeth extracted and estimated blood loss in various groups. ResultsSeventy-one patients underwent full-mouth extraction with removal of an average of 19 teeth. The authors excluded 3 patients owing to lack of data regarding blood loss. Of the remaining 68 patients, 25 were using aspirin, 12 were using clopidogrel, 9 were using both aspirin and clopidogrel, and 22 had discontinued the use of antiplatelets. There was no significant difference in the number of teeth extracted (P = .283) and estimated blood loss (P = .111) among the 4 groups. The authors found a significant moderate correlation between the number of teeth extracted and estimated blood loss in the group using aspirin (r = 0.537; P = .006) and in the group using clopidogrel, whether alone or in combination with aspirin (r = 0.535; P = .012), but not in the group who discontinued the use of antiplatelets. There was no need for blood transfusion in any patient. ConclusionsThe results of this study provide limited evidence to suggest that continuation of clopidogrel during full-mouth extraction and preprosthetic surgery may be safe and does not appear to be associated with a significant risk of bleeding. Practical ImplicationsClopidogrel therapy during full-mouth extraction is not associated with significant bleeding complications and may be continued in patients who have a high risk of experiencing a cardiac event.

Platelet transfusion reverses bleeding evoked by triple anti-platelet therapy including vorapaxar, a novel platelet thrombin receptor antagonist

Vorapaxar is a novel protease-activated receptor-1 (PAR-1) antagonist recently approved for the reduction of thrombotic cardiovascular events in patients with a history of myocardial infarction or with peripheral arterial disease. Patients who received vorapaxar in addition to standard of care antiplatelet therapy had an increased incidence of major bleeding events compared with placebo. To assess whether platelet transfusion can restore hemostasis in primates on triple antiplatelet therapy, template bleeding times were assessed concurrently in the buccal mucosa, finger pad, and distolateral tail of anesthetized cynomolgus macaques to evaluate bleeding with vorapaxar as either monotherapy or in combination with aspirin or aspirin and clopidogrel. Aspirin (5mg/kg, IV) or vorapaxar (1mg/kg, PO) alone had no significant effect on bleeding times in the three vascular beds examined. A modest (<2-fold) increase in bleeding time was achieved in the three beds with the dual combination of aspirin and vorapaxar. Major increases in bleeding time were achieved in the three beds with the triple combination of aspirin (5mg/kg, IV), vorapaxar (1mg/kg, PO), and clopidogrel (1mg/kg, PO). Transfusion of fresh human platelet rich plasma, but not platelet poor plasma, reversed the increase in bleeding time in the triple therapy group. Transfusion of human platelets may be a viable approach in situations requiring a rapid reversal of platelet function in individuals treated with triple anti-platelet therapy that includes vorapaxar.

Effect of clopidogrel combined with aspirin in the treatment of elderly patients with coronary heart disease

Objective To observe the effect of clopidogrel in combination with aspirin to treat senile coronary heart disease and its influence on relevant indicators. Methods Clinical data of 200 elderly patients with coronary heart disease(CHD) were retrospectively analyzed, according to different therapeutic methods, they were divided into the two groups, 100 cases in each group, the two groups on the basis of conventional stable plaques, expand coronary targeted treatment, the control group treated with oral aspirin enteric- coated metformin hydrochloride, the observation group treated with aspirin combined clopidogrel treatment. The clinical efficacy of the two groups, the cardiac function indexes before and after treatment,blood coagulation indexes, as well as the adverse reaction of the two groups of patients were observed. Results The total effective rate of the observation group was 93.0%, which was significantly higher than 77.8% of the control group(χ2= 4.142,P< 0.05);In the observation group after treatment, the cardiac function indexes LVEF,SV,CO were significantly higher than the control group(t= 2.475,2.397,3.052,all P< 0.05);The MAADP, platelet inhibition rate after treatment in both groups before treatment and platelet aggregation rate and other indicators and comparative differences were statistically significant(t= 8.293,12.285,10.384,all P<0.05); In the observation group after treatment,the MAADP,platelet inhibition rate and platelet aggregation rate index difference compared with the control group after treatment were statistically significant(t= 6.682,8.668,8.051,all P <0.05);In the two groups,the FIB levels after treatment compared with before treatment differences were statistically significant(t= 2.375,4.393,all P< 0.05);In the observation group after treatment,the plasma FIB level compared with the control group after treatment differences was statistically significant(t= 2.186,P<0.05);In the two groups after treatment,the indexes of TC,TG,HGL and LDL levels compared with before treatment differences were statistically significant(t= 3.226,2.834,2.448,2.834,3.006,2.927,2.446,2.927,all P< 0.05); Again hair the comparison of the number of coronary heart disease, readmission, the observation group was better than that of control group(χ2= 4.126,8.256,all P< 0.05). Conclusion Clopidogrel in combination with aspirin can more effectively by platelet aggregation and inhibit blood coagulation function to achieve fast and efficient antithrombotic effect, improve the treatment of coronary artery disease clinical curative effect and heart function,and short-term use safety is good. Key words: Coronary Artery Disease; Aged; Clopidogrel; Aspirin

Mo1156 Predictors for Elevation in Serum Gastrin Following Proton Pump Inhibitor Treatment

Background: It has been suggested that proton pump inhibitors (especially omeprazole and esomeprazole) may reduce the effectiveness of clopidogrel's anti-platelet activity possibly reflecting inhibition of Cytochrome P450 (CYP) 2C19, a hepatic iso-enzyme responsible for conversion of the agent from pro-drug to its active moiety. Whether differences exist between PPIs types on reduction in platelet inhibition during simultaneous PPI and clopidogrel therapy however remains uncertain. The aim of this study was to compare the effects of different PPIs on clopidogrel-mediated platelet inhibition using platelet aggregometry. Methods: 53 patients (29 men, mean age 79±10yrs) concurrently treated with clopidogrel and PPIs were identified. 57%were receiving pantoprazole, 19% omeprazole, 15% esomeprazole, 6% rabeprazole, and 3% lansoprazole. Platelet reactivity was determined on 5ml fresh blood using the Accumetrics VerifyNow® assay system. Results were expressed as P2Y12 platelet reactivity units (PRU) with a value of >235 units indicating suboptimal inhibition of clopidogrel-mediated anti-platelet activity.[i] PRU values were compared for different PPIs using Student's t-test. The prevalence of sub-optimal platelet inhibition was compared with Fisher's exact test. Results: The PRU was >235 in 13 of 53 patients (25%). Of these, 4 were receiving pantoprazole (13% of total patients taking pantoprazole), 4 esomeprazole (4/8, 50%), and the remaining 5 patients omeprazole (5/10, 50%). PRU values in the 5 patients receiving lansoprazole or rabeprazole were 235 compared to patients treated with pantoprazole, lansoprazole or rabeprazole (p<0.05). The mean PRU in subjects <80 years was 152.2±16.15 versus 200.0±11.93 in subjects who were aged over 80 (p= 0.0183). Conclusion: Patients receiving a combination of clopidogrel with either esomeprazole or omeprazole have a higher incidence of suboptimal inhibition of clopidogrelmediated platelet activity when compared to other PPIs. Monitoring of platelet function should be considered in patients at high risk of cardiovascular events who receive concurrent clopidogrel and PPI therapy. [i] M.J. Price et al. Prognostic significance of post-clopidogrel platelet reactivity assessed by a point-of-care assay on thrombotic events after drug-eluting stent implantation., European Heat Journal (2008) 29, 992-1000.