Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
Cardiol J. 2009;16(6):535-44.
Antiplatelet therapy has proven beneficial in the treatment of cardiovascular disease. Proton pump inhibitors (PPIs) are commonly used for gastroprotection in patients receiving antiplatelet therapy. Several trials have been carried out to establish interactions between PPIs, clopidogrel and soluble formulations of aspirin, but no studies with PPIs and enteric-coated (EC) forms of aspirin have been conducted. The aim of this study was to assess if concomitant pantoprazole usage influences antiplatelet effect of EC aspirin in patients with acute coronary syndrome treated with percutaneous coronary intervention (PCI) and dual antiplatelet therapy.
Thirty-one consecutive patients were prospectively enrolled in the randomized, crossover, open-labelled designed study. The first 16 patients were given orally 40 mg of pantoprazole for the first four days while the next 15 subjects were treated with pantoprazole from the fifth to the eighth day of hospitalisation. Blood samples were collected at 6.00 a.m., 10.00 a.m., 2.00 p.m., and 7.00 p.m. on the fourth and eighth day of hospitalization. Aggregation in response to arachidonic acid was assessed in the whole blood on a new generation impedance aggregometer.
Lower overall platelet aggregation in patients treated with pantoprazole (p < 0.03) was observed. When aggregation of platelets was analyzed separately at different times, the differences reached statistical significance six hours after the administration of pantoprazole and antiplatelet agents. The highest absolute difference in arachidonic acid-dependent aggregation was observed two hours after drug ingestion.
Co-administration of pantoprazole may enhance the antiplatelet effect of enteric-coated aspirin in patients with acute coronary syndrome undergoing PCI.
抗血小板治疗已被证明对心血管疾病的治疗有益。质子泵抑制剂（PPIs）常用于接受抗血小板治疗的患者的胃保护。已经进行了几项试验来确定 PPI 与氯吡格雷和阿司匹林可溶性制剂之间的相互作用，但尚未进行与 PPI 和肠溶阿司匹林（EC）形式的研究。本研究旨在评估在接受经皮冠状动脉介入治疗（PCI）和双联抗血小板治疗的急性冠脉综合征患者中，同时使用泮托拉唑是否会影响 EC 阿司匹林的抗血小板作用。
31 例连续患者前瞻性纳入随机、交叉、开放标签设计的研究。前 16 例患者在入院的前四天每天口服 40mg 泮托拉唑，而接下来的 15 例患者在入院的第五至第八天接受泮托拉唑治疗。在入院的第四天和第八天，分别在上午 6 点、上午 10 点、下午 2 点和晚上 7 点采集血样。在新一代阻抗聚集仪上评估全血对花生四烯酸的聚集反应。
与接受泮托拉唑治疗的患者相比（p<0.03），接受泮托拉唑治疗的患者整体血小板聚集率较低。当分别分析血小板聚集在不同时间的情况时，在给予泮托拉唑和抗血小板药物六小时后差异达到统计学意义。在药物摄入后两小时观察到花生四烯酸依赖性聚集的最大绝对差异。
在接受 PCI 的急性冠脉综合征患者中，同时使用泮托拉唑可能会增强 EC 阿司匹林的抗血小板作用。
