Kwan Joanne, Htun Wah Wah, Huang Yili, Ko Wilson, Kwan Tak W
Boston University, Boston, MA, USA.
Vasc Health Risk Manag. 2011;7:399-404. doi: 10.2147/VHRM.S22273. Epub 2011 Jun 24.
The purpose of this study was to examine the effect of proton pump inhibitors (PPI) on the antiplatelet activity of clopidogrel in a consecutive series of Chinese patients after they had received coronary stents.
A sample of 51 consecutive Chinese patients treated with coronary stents and taking PPI and clopidogrel for more than 30 days were enrolled in this study. Mean values for platelet residual units and percentage inhibition before PPI (+PPI) and 14 days after discontinuation of PPI (-PPI) were compared using the paired t-test.
There was no effect of concomitant use of esomeprazole and clopidogrel or omeprazole and clopidogrel on the inhibition assay, but platelet residual units and percentage inhibition showed statistically significant improvement after stopping lansoprazole in Chinese patients who were on chronic clopidogrel therapy. Clopidogrel resistance existed more frequently in the Chinese-American population examined, and was as high as 68% (+PPI) to 73% (-PPI).
The clopidogrel resistance found is cause for concern, although its relationship with clinical events is currently unknown in this population. Further study with other thienopyridines or genetic variant analysis is suggested.
本研究旨在探讨质子泵抑制剂（PPI）对一系列连续的中国冠状动脉支架置入术后患者中氯吡格雷抗血小板活性的影响。
本研究纳入了51例连续接受冠状动脉支架置入术且服用PPI和氯吡格雷超过30天的中国患者。使用配对t检验比较PPI治疗前（+PPI）和停用PPI 14天后（-PPI）血小板残余单位和抑制百分比的平均值。
埃索美拉唑与氯吡格雷或奥美拉唑与氯吡格雷联合使用对抑制试验无影响，但在接受氯吡格雷长期治疗的中国患者中，停用兰索拉唑后血小板残余单位和抑制百分比有统计学意义的改善。在所研究的华裔美国人中，氯吡格雷抵抗更为常见，高达68%（+PPI）至73%（-PPI）。
尽管目前该人群中氯吡格雷抵抗与临床事件的关系尚不清楚，但所发现的氯吡格雷抵抗令人担忧。建议进一步研究其他噻吩并吡啶类药物或进行基因变异分析。
