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Lin SF, Lin PC, Chang CC, Chang WL, Chu FY. Investigation of the interaction between proton pump inhibitors and clopidogrel using VerifyNow P2Y12 assay. Medicine (Baltimore) 2020; 99:e23695. [PMID: 33327360 PMCID: PMC7738015 DOI: 10.1097/md.0000000000023695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/11/2020] [Accepted: 11/13/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Randomized trials and observation studies have revealed conflicting results regarding the interaction between clopidogrel and proton pump inhibitors (PPIs). The aim of our study was to provide laboratory evidence regarding whether PPIs blunt the antiplatelet reactivity of clopidogrel. METHODS We included records of Asian patients who received clopidogrel treatment for cardiovascular or cerebrovascular events and the VerifyNow P2Y12 assay for platelet reactivity monitoring. The responsiveness of antiplatelet effect to clopidogrel was analyzed according to 3 criteria:Results: Patients treated without PPIs did not differ significantly from those concomitantly treated with PPIs in terms of levels of PI (25.7% ± 24.3% vs 23.0 ± 25.3%, P = .4315), PRU (187.3 ± 74.0 vs 197.4 ± 77.3, P = .3373), or responsiveness to antiplatelet (adjusted absolute risk, 3.5%; 95% confidence interval, - 10.7 to 17.7%; P = .6297). Patients treated with lansoprazole, esomeprazole, pantoprazole, and rabeprazole exhibited no significant differences in PRU or PI levels compared with those treated without PPIs. By contrast, patients treated with dexlansoprazole exhibited a significantly decreased level of PI (25.7% ± 24.3% vs 14.0% ± 21.6%, P = .0297) and responsiveness to clopidogrel under the criterion PI > 20% (adjusted absolute risk: 10.5%; 95% confidence interval: 2.6% to 43.6%; P = .0274). CONCLUSION No robust interaction between clopidogrel and PPIs was found, but caution should be exercised in the concomitant use of dexlansoprazole and clopidogrel in Asians.
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Affiliation(s)
- Sheng-Feng Lin
- School of Public Health, College of Public Health, Taipei Medical University, Taipei
- Department of Clinical Pathology, Far Eastern Memorial Hospital
- Department of Neurology, Far Eastern Memorial Hospital
- Division of Hospitalist, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei
| | - Pei-Chin Lin
- Department of Clinical Pathology, Far Eastern Memorial Hospital
| | - Chih-Chun Chang
- Department of Clinical Pathology, Far Eastern Memorial Hospital
- Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, Yilan
| | - Wei-Lun Chang
- Department of Pharmacy, Far Eastern Memorial Hospital, New Taipei
| | - Fang-Yeh Chu
- Department of Clinical Pathology, Far Eastern Memorial Hospital
- Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan City
- Department of Medical Laboratory Science and Biotechnology, Yuanpei University of Medical Technology, Hsinchu City
- School of Medical Laboratory Science and Biotechnology, Taipei Medical University, Taipei City, Taiwan
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Xu LX, Chen KY, Liu T, Zheng XT, Jiao ZQ, Xu Y, Li G. Adjunctive loading dose of cilostazol in preventing periprocedural myocardial infarction. Cardiovasc Ther 2016; 34:225-33. [PMID: 27133311 DOI: 10.1111/1755-5922.12192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Ling-Xia Xu
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Kang-Yin Chen
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Tong Liu
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Xin-Tian Zheng
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Zhan-Quan Jiao
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Yanmin Xu
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Guangping Li
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
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H A, N E, S A, S C, K D, C A, E T, A T, O C Y, M G, T B, M M. The Effect of High Dose Cilostazol and Rosuvastatin on Periprocedural Myocardial Injury in Patients with Elective Percutaneous Coronary Intervention. ACTA CARDIOLOGICA SINICA 2016; 31:292-300. [PMID: 27122885 DOI: 10.6515/acs20150119b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The aim of our study was to assess the effect of pretreatment with cilostazol and rosuvastatin combination before elective percutaneous coronary intervention (PCI) on peri-procedural myocardial injury (PPMIJ). METHODS We randomly assigned 172 patients with stable angina pectoris scheduled for elective PCI to pre- treatment with Cilostazol 200mg and Rosuvastatin 40 mg (group 1), or to pretreatment with Rosuvastatin 40 mg group (group 2). The primary end-point was the occurrence of PPMIJ defined as any cardiac troponin I (Tn I) level elevated above the upper normal limit (UNL). The occurrence of peri-procedural myocardial infarction (PPMIN) was defined as a post-procedural increase in cTnI level ≥ 5 times above the UNL. RESULTS There was no significant difference in baseline characteristics between group 1 (n = 86) and group 2 (n = 86). The rate of PPMIJ (21% vs. 24%, p = 0.58) and PPMIN (2.3% vs. 7%, p = 0.27) were similar between the two study groups. Subgroup analysis performed on those patients without statin therapy before PCI (53 patients in group 1 and 50 patients in group 2) showed that the incidence of PPMIJ was significantly lower in the group 1 patients without chronic statin treatment [17% (9/53) versus 34% (17/50); p = 0.04], but the rate of PPMIN was similar between the two groups for those patients without chronic statin treatment [1.9% (1/53) versus 10% (5/50); p = 0.07]. CONCLUSIONS We found that adjunct cilostazol and rosuvastatin pre-treatment did not significantly reduce PPMIJ after elective PCI in patients with stable angina pectoris. However, adjunct cilostazol pre-treatment could reduce PPMIJ in patients without chronic statin therapy before elective PCI. KEY WORDS Cilostazol; Myocardial injury; Percutaneous coronary intervention; Statin.
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Affiliation(s)
- Ari H
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa
| | - Emlek N
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa
| | - Ari S
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa
| | - Coşar S
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa
| | - Doğanay K
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa
| | - Aydin C
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa
| | - Tenekecioğlu E
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa
| | - Tütüncü A
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa
| | - Yontar O C
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa
| | - Gürdoğan M
- Edirne State Hospital, Department of Cardiology, Edirne, Turkey
| | - Bozat T
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa
| | - Melek M
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa
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Wang M, Zhang G, Wang Y, Zhou K, Liu T, Zhang Y, Guo A, An Y, Zhang X, Li Y. Bivalirudin plus loading dose of cilostazol-based triple-antiplatelet in treatment of non-ST-elevation myocardial infarction following percutaneous coronary intervention. Ther Clin Risk Manag 2015; 11:1469-73. [PMID: 26451112 PMCID: PMC4592053 DOI: 10.2147/tcrm.s86799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective To study the effect of bivalirudin plus loading dose of cilostazol-based triple-antiplatelet therapy strategy in patients undergoing percutaneous coronary intervention (PCI). Methods One hundred and fifty-three patients with non-ST-segment elevation myocardial infarction who underwent PCI were divided into control group and cilostazol group. Patients in control group were given aspirin and clopidogrel and those in cilostazol group were given aspirin, clopidogrel, and cilostazol once 2 hours before PCI and for 30 days after PCI. Bivalirudin was given to all patients before and during the PCI. Results After PCI, the Thrombolysis In Myocardial Infarction myocardial perfusion grade (TMPG) III in cilostazol group was higher than that in control group (89.19% versus 72.15%, P<0.05). At 30 days, the incidence of major adverse cardiac events was significantly lower in cilostazol group compared with that in control group (6.76% versus 17.72%, P<0.05). However, the rates of cardiac death, nonfatal reinfarction, target vessel revascularization, new congestive heart failure, and subacute stent thrombosis did not significantly differ between the two groups. In addition, the rates of minor or major bleeding or thrombocytopenia did not significantly differ between the two groups. Conclusion Bivalirudin plus loading dose of cilostazol-based triple-antiplatelet therapy strategy in PCI increased TMPG III, decreased major adverse cardiac events, and did not increase the incidence of bleeding and thrombocytopenia.
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Affiliation(s)
- Mei Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Guoru Zhang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yaling Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Kun Zhou
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Tao Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yang Zhang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Anjun Guo
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yu An
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Xiaodan Zhang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yongjun Li
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
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Bangalore S, Singh A, Toklu B, DiNicolantonio JJ, Croce K, Feit F, Bhatt DL. Efficacy of cilostazol on platelet reactivity and cardiovascular outcomes in patients undergoing percutaneous coronary intervention: insights from a meta-analysis of randomised trials. Open Heart 2014; 1:e000068. [PMID: 25332804 PMCID: PMC4189225 DOI: 10.1136/openhrt-2014-000068] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/30/2014] [Accepted: 07/15/2014] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Cilostazol overcomes high on-treatment platelet reactivity (HTPR) and reduces adverse cardiovascular (CV) outcomes after percutaneous coronary intervention (PCI). However, the role for triple antiplatelet therapy (TAPT) with cilostazol in addition to aspirin and clopidogrel after PCI is not well defined. METHODS We conducted a MEDLINE/EMBASE/CENTRAL search for randomised trials, until May 2014, evaluating TAPT compared with dual antiplatelet therapy (DAPT) of aspirin and clopidogrel alone in patients undergoing PCI and reporting platelet reactivity and/or CV outcomes. The primary platelet reactivity outcome was differences in platelet reactivity unit (PRU) with secondary outcomes of %platelet inhibition and rate of HTPR. The primary CV outcome was major adverse cardiovascular events (MACE), with secondary outcomes of death, cardiovascular death, myocardial infarction, stent thrombosis (ST), target lesion revascularisation (TLR) and target vessel revascularisation (TVR) as well as safety outcomes of bleeding and drug discontinuations. RESULTS In 17 trials that evaluated platelet reactivity outcomes, the mean PRU value was 47.73 units lower with TAPT versus DAPT (95% CI -61.41 to -34.04, p<0.0001; mean PRU 182.90 vs 232.65). TAPT also increased platelet inhibition by 12.71% (95% CI 10.76 to 14.67, p<0.0001), and led to a 60% reduction in the risk of HTPR (relative risk=0.40; 95% CI 0.30 to 0.53) compared with DAPT. Moreover, among the 34 trials that evaluated CV outcomes, TAPT reduced the risk of MACE (incident rate ratio (IRR)=0.68; 95% CI 0.60 to 0.78), TLR (IRR=0.57; 95% CI 0.44 to 0.73), TVR (IRR=0.69; 95% CI 0.59 to 0.81) and ST (IRR=0.63; 95% CI 0.40 to 0.98) with no difference for other outcomes including bleeding, even in trials using drug-eluting stents. Drug discontinuation due to adverse effects was, however, higher with TAPT vs DAPT (IRR=1.59; 95% CI 1.32 to 1.91). CONCLUSIONS In patients undergoing PCI, addition of cilostazol to DAPT results in decreased platelet reactivity and a significant reduction in CV outcomes including ST, even in the drug-eluting stent era.
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Affiliation(s)
| | - Amita Singh
- New York University School of Medicine, New York, New York, USA
| | - Bora Toklu
- New York University School of Medicine, New York, New York, USA
| | | | - Kevin Croce
- Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Frederick Feit
- New York University School of Medicine, New York, New York, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, USA
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Relationship between changes in platelet reactivity and ischemic events following percutaneous coronary intervention: A meta-regression analysis of 30 randomized trials. Atherosclerosis 2014; 234:176-84. [DOI: 10.1016/j.atherosclerosis.2014.02.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/04/2014] [Accepted: 02/19/2014] [Indexed: 11/15/2022]
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Influence of platelet reactivity and inflammation on peri-procedural myonecrosis in East Asian patients undergoing elective percutaneous coronary intervention. Int J Cardiol 2013; 168:427-35. [PMID: 23068571 DOI: 10.1016/j.ijcard.2012.09.132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/03/2012] [Accepted: 09/22/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES The contribution of multiple risk factors to peri-procedural myocardial infarction (PMI) in East Asians remains controversial. To assess the influence of clinical or laboratory covariates on PMI in these patients. METHODS Stable patients (n=341) undergoing elective percutaneous coronary intervention (PCI) were enrolled. Platelet reactivity was measured by conventional aggregometry and VerifyNow. Inflammation markers and lipid profile were determined by standard methods. PMI was defined according to Universal definition (troponin I or CK-MB ≥ 3 times the 99th percentile of the upper reference limit). RESULTS PMI (defined by troponin I and CK-MB) occurred in 47 (13.8%) and 30 (8.8%) patients, respectively. There was no significant difference in ADP-induced platelet reactivity between patients with vs. without PMI. Patients with PMI (troponin I) had higher levels of 6 μg/mL collagen-induced platelet aggregation (PA) and VerifyNow 'BASE' compared with those without PMI. The combination of '6 μg/mL collagen-induced PA>40%'+'BASE>318' (odds ratio, 14.08; 95% confidence intervals, 1.68 to 111.11; p=0.015) or 'WBC>6550/mm(3)'+'C-reactive protein>2.3mg/L' (odds ratio, 7.75; 95% confidence intervals, 2.49 to 24.39; p<0.001) was associated with an increased risk of PMI (troponin I). The greatest likelihood ratio was observed when cholesterol, inflammation marker and platelet function were combined together. CONCLUSION This is the first study to demonstrate that heightened platelet responsiveness to collagen and thrombin may be a risk factor for myonecrosis in patients undergoing elective PCI. The utility of the combining measures of platelet function, inflammation and cholesterol to enhance risk stratification and thus facilitate personalized therapy deserves further study.
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