Thursday, August 4, 2011

Clopidogrel efficacy of antiplatelet

Based on the results of research conducted by dr. Pamela Moceri MD and colleagues from the Cardiology Department, Pasteur University Hospital of Nice, Nice, France, can be concluded that the decrease in effectiveness of clopidogrel because of clopidogrel in conjunction with the PPI can be overcome by increasing the dose of clopidogrel to 2-fold, or replace the PPI with ranitidine.

Apparently from the results of this study increased attention to interactions that may occur and decrease the effectiveness of antiplatelet agent clopidogrel. In 2009, the FDA (Food and Drug Administration) warnings regarding the concurrent administration of clopidogrel with omeprazole. In his warning, the FDA also stated that patients with high risk of heart attacks and strokes are treated with clopidogrel will not gain the full benefit of clopidogrel when administered together with omeprazole. FDA at that time recommend changes to the label clopidogrel with a new celebration, the interaction of clopidogrel with omeprazole and other drugs that inhibit the enzyme CYP2C19. Patients who were treated using clopidogrel and require medications that reduce stomach acid is recommended to be treated using H2 antagonists such as ranitidine or famotidine, because the FDA has confidence that these drugs do not interact with clopidogrel. While drugs are not recommended in conjunction with clopidogrel dosing among others such as cimetidine, fluconazole, ketoconazole, voriconazole, etravirine, felbamate, fluoxetine, fluvoxamine, and ticlopidine.

Clopidogrel has been used extensively to overcome aterotrombotik events, both in patients with cardiovascular events, cerebrovascular, and peripheral arterial disease, as well as in patients with high cardiovascular risk. In studies such as CAPRIE, CURE, CLARITY-TIMI well as other research, the
effectiveness of clopidogrel no doubt as one of the mainstay of anti-platelet that can reduce cardiovascular events. Drug-drug class of PPI (proton pump inhibitor) is often given in conjunction with clopidogrel-aspirin to prevent gastric bleeding. However, research OCLA (OCLA: Influence of Omeprazole on the Antiplatelet Action of Clopidogrel Associated to Aspirin), showed that omeprazole significantly reduced the ability of clopidogrel in inhibiting platelet as shown from the results of testing with the VASP (vasodilator-stimulated phosphoprotein phosphorylation).


A study conducted by dr. Pamela Moceri MD and colleagues from the Cardiology Department, Pasteur University Hospital of Nice, Nice, France, to examine the effects of esomeprazole and ranitidine on the antiplatelet effect of clopidogrel and aspirin, as well as to determine whether increasing the dose of clopidogrel may improve the effectiveness of anti-platelet loss due to esomeprazol.

The research conducted was a prospective, randomized, cross. Examination of platelet reactivity to aspirin 75 mg and clopidogrel 150 mg performed with / without esomeprazole and ranitidine and use the VerifyNow system. Examination carried out in 4 stages, each carried out for 7 days. Phase 1: aspirin 160 mg and clopidogrel 75 mg; Phase 2: aspirin 160 mg + clopidogrel 75 mg + 20 mg esomeprazole; Stage 3: aspirin 160 mg + 150 mg + clopidogre esmeprazole 20 mg; and Phase 4: 160 mg of aspirin + clopidogrel 75 mg + 150 mg ranitidine. The results are collected in P2Y12 Reaction Units (PRU%) and Aspirin Reaction Units (ARU).

The results showed that in 21 patients with coronary artery disease, esomeprazole reduces the effectiveness of clopidogrel with decreased 38.6% ± 24 PRU (p <0.001) (average absolute difference -16.7 PRU% [-21; -12.5]), and increase the incidence low response to clopidogrel by 8-fold (PRU persebntase patients with <20%). In addition it is known that increased doses of clopidogrel to 2-fold improve platelet response to clopidogrel.

Dr. Pamela Moceri and colleagues conclude that there is a strong negative interaction between clopidogrel with esomeprazol, which can be overcome by increasing the dose of clopidogrel to 2-fold, or substitute esomeprazole with ranitidine. This is a simple solution to overcome the effects of clopidogrel for reduction in PPI.

adopted from www.ugghani.blogspot.com


Xtreme Fat Loss Diet System!

No comments:

Post a Comment

Followers