Department of Cardiology, Tzanio Hospital, Piraeus, Greece.
Can J Cardiol. 2010 Feb;26(2):e54-7. doi: 10.1016/s0828-282x(10)70008-8.
Because clopidogrel is converted to its active metabolite by P450 isoenzymes, which are also involved in the metabolism of omeprazole, there is concern regarding whether the action of clopidogrel would be reduced in patients also taking omeprazole.
To evaluate the impact of omeprazole administration on the effectiveness of clopidogrel drug therapy during the first year following successful coronary stenting (CS).
A total of 588 consecutive patients who underwent successful CS for stable or unstable coronary artery disease were studied. Patients were classified into those who were treated (group A, n=340) or not treated (group B, n=248) with omeprazole for seven or more consecutive days during the entire observation period. The composite of cardiac death or rehospitalization for nonfatal myocardial infarction during the first year was the prespecified primary study end point.
Baseline characteristics, and dual clopidogrel and acetylsalicylic acid drug therapy were well balanced between the study groups. By one year, the primary end point was reached by 58 (9.9%) patients, including 20 (3.4%) who died due to cardiac reasons and 38 (6.5%) who were rehospitalized because of a nonfatal myocardial infarction. Patients in groups A and B, respectively, were at similar risk of the primary composite end point (10% versus 9.7%, hazard ratio 1.1 [95% CI 0.6 to 1.8]; P=0.89).
According to the results of the present study, treatment with omeprazole had no impact on the clinical efficacy of clopidogrel drug therapy during the first year after successful CS.
氯吡格雷通过细胞色素 P450 同工酶转化为其活性代谢物，而这些同工酶也参与奥美拉唑的代谢，因此人们担心同时服用奥美拉唑会降低氯吡格雷的作用。
评估奥美拉唑给药对成功经皮冠状动脉介入治疗（PCI）后第一年氯吡格雷药物治疗效果的影响。
共纳入 588 例因稳定性或不稳定性冠状动脉疾病成功接受 PCI 的连续患者。患者分为奥美拉唑治疗组（A 组，n=340）和未治疗组（B 组，n=248），奥美拉唑治疗持续时间≥7 天。主要研究终点为第一年心脏性死亡或非致死性心肌梗死再住院的复合终点。
两组患者的基线特征和双联氯吡格雷及乙酰水杨酸药物治疗情况相当。随访 1 年，A 组有 58 例（9.9%）患者达到主要终点，其中 20 例（3.4%）患者因心脏原因死亡，38 例（6.5%）患者因非致死性心肌梗死再住院。A 组和 B 组患者的主要复合终点风险相似（10%比 9.7%，风险比 1.1[95%置信区间 0.6~1.8]；P=0.89）。
根据本研究结果，奥美拉唑治疗对 PCI 成功后第一年氯吡格雷药物治疗的临床疗效无影响。
