Effect of proton pump inhibitors on platelet inhibition activity of clopidogrel in Chinese patients with percutaneous coronary intervention

Joanne Kwan¹, Wah Wah Htun², Yili Huang³, Wilson Ko³, Tak W Kwan^3
1Boston University, Boston, MA, USA; ²Lutheran Medical Center, Brooklyn, NY, USA; ³Beth Israel Medical Center, New York, NY, USA

Background: 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.
Methods: 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.
Results: 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).
Conclusion: 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.

Keywords: proton pump inhibitors, clopidogrel resistance, Chinese population, percutaneous coronary intervention