title: Pantoprazole may enhance antiplatelet effect of enteric-coated aspirin in patients with acute coronary syndrome.
abstract: BACKGROUND
  Antiplatelet therapy has proven beneficial in the treatment of cardiovascular disease. Proton pump inhibitors (PPIs) are commonly used for gastroprotection in patients receiving antiplatelet therapy. Several trials have been carried out to establish interactions between PPIs, clopidogrel and soluble formulations of aspirin, but no studies with PPIs and enteric-coated (EC) forms of aspirin have been conducted. The aim of this study was to assess if concomitant pantoprazole usage influences antiplatelet effect of EC aspirin in patients with acute coronary syndrome treated with percutaneous coronary intervention (PCI) and dual antiplatelet therapy.
  
  
  METHODS
  Thirty-one consecutive patients were prospectively enrolled in the randomized, crossover, open-labelled designed study. The first 16 patients were given orally 40 mg of pantoprazole for the first four days while the next 15 subjects were treated with pantoprazole from the fifth to the eighth day of hospitalisation. Blood samples were collected at 6.00 a.m., 10.00 a.m., 2.00 p.m., and 7.00 p.m. on the fourth and eighth day of hospitalization. Aggregation in response to arachidonic acid was assessed in the whole blood on a new generation impedance aggregometer.
  
  
  RESULTS
  Lower overall platelet aggregation in patients treated with pantoprazole (p < 0.03) was observed. When aggregation of platelets was analyzed separately at different times, the differences reached statistical significance six hours after the administration of pantoprazole and antiplatelet agents. The highest absolute difference in arachidonic acid-dependent aggregation was observed two hours after drug ingestion.
  
  
  CONCLUSIONS
  Co-administration of pantoprazole may enhance the antiplatelet effect of enteric-coated aspirin in patients with acute coronary syndrome undergoing PCI.
authors: Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland. medkas@tlen.pl
authors: Michał
authors: M
authors: Kasprzak
authors: Marek
authors: M
authors: Koziński
authors: Liliana
authors: L
authors: Bielis
authors: Joanna
authors: J
authors: Boinska
authors: Wioleta
authors: W
authors: Plazuk
authors: Agata
authors: A
authors: Marciniak
authors: Jacek
authors: J
authors: Budzyński
authors: Jolanta
authors: J
authors: Siller-Matula
authors: Danuta
authors: D
authors: Rość
authors: Jacek
authors: J
authors: Kubica
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use*; D054058:Acute Coronary Syndrome / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D016718:Arachidonic Acid; D001241:Aspirin / Q000627:therapeutic use*; D000077144:Clopidogrel; D017023:Coronary Angiography; D018592:Cross-Over Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077402:Pantoprazole; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010979:Platelet Function Tests; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D015607:Stents; D013608:Tablets, Enteric-Coated; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D013608:Tablets, Enteric-Coated; D016718:Arachidonic Acid; D000077144:Clopidogrel; D000077402:Pantoprazole; D013988:Ticlopidine; D001241:Aspirin