title: Effect of clopidogrel with or without omeprazole in patients with carotid artery stenting.
abstract: BACKGROUND
  Recent concerns have been raised about the potential for proton pump inhibitors (PPIs) to blunt the efficacy of clopidogrel. We observed the effect of clopidogrel plus aspirin with or without omeprazole in patients with carotid stenoses after they received placement of carotid stents.
  
  
  METHODS
  Sixty-four consecutive patients treated with percutaneous carotid artery stenting (CAS) comprised the sample. All enrolled patients underwent the C13 urea breath test (C13 UBT) before CAS. Patients with Helicobacter pylori infection and a history of peptic ulcer were assigned dual antiplatelet combination with omeprazole. Others received dual antiplatelet without omeprazole. Transcranial Doppler and ultrasonography were performed to assess the middle cerebral artery and carotid artery in follow-up at three months and six months.
  
  
  RESULTS
  Eight patients had gastrointestinal bleeding; the event rate was 22.6% without omeprazole and 3.8% with omeprazole. The rate of gastrointestinal bleeding was reduced with omeprazole as compared without omeprazole (p = 0.026, p < 0.05). The two groups did not differ significantly in the rate of in-stent restenosis and thrombus through transcranial Doppler and ultrasonography.
  
  
  CONCLUSIONS
  Among patients receiving dual antiplatelet therapy, prophylactic use of omeprazole reduced the rate of upper gastrointestinal bleeding. There was no apparent interaction between clopidogrel and omeprazole in patients with carotid artery stenting.
authors.affiliation: Department of Neurology, Affiliated Hospital of Ningxia Medical University, Yinchuan, China.
authors.forename: B
authors.initials: B
authors.lastname: Ma
authors.affiliation: Department of Gastroenterology, Affiliated Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui, Autonomous Region 750004, China.
authors.forename: L
authors.initials: L
authors.lastname: Hang
authors.affiliation: Department of Neurology, Affiliated Hospital of Ningxia Medical University, Yinchuan, China.
authors.forename: G
authors.initials: G
authors.lastname: Chen
authors.affiliation: Department of Neurology, Affiliated Hospital of Ningxia Medical University, Yinchuan, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Du
mesh_terms: D000792:Angiography; D001241:Aspirin / Q000627:therapeutic use; D001944:Breath Tests; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D000077144:Clopidogrel; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use*; D010437:Peptic Ulcer / Q000150:complications / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D000077144:Clopidogrel; D009853:Omeprazole; D013988:Ticlopidine; D001241:Aspirin