Influence of different proton pump inhibitors on platelet function in acute myocardial infarction patients receiving clopidogrel treatment after percutaneous coronary intervention

The objective of the present study is to investigate the effect of clopidogrel and proton pump inhibitors (PPIs) on upper gastrointestinal bleeding and adverse cardiovascular events in acute myocardial infarction (MI) patients after percutaneous coronary intervention (PCI). A total of 240 patients receiving emergent PCI due to acute MI were recruited from January 2009 to November 2010. After admission, patients were treated with aspirin (300 mg) and clopidogrel (600 mg) on the first day and then with aspirin at 100 mg/d and clopidogrel at 75 mg/d for antiplatelet therapy. These patients were randomly assigned into Omeprazole (40 mg/d) group (n=83), Pantoprazole (40 mg/d) group (n=80) and Famotidine (40 mg/d) group (n=77). Treatment was done for 5-7 days and patients were followed up for 1 month. The gastrointestinal bleeding and in-stent restenosis were observed. There was no marked difference in the incidence of gastrointestinal bleeding between Omeprazole group and Pantoprazole group, but that in the former two groups was significantly higher than in the Famotidine group. No dramatic difference was observed in the incidence of in-stent restenosis among three groups. Treatment with PPI may not increase the risk for in-stent re-stenosis in acute MI patients receiving PCI, but PPI treatment can significantly reduce the incidence of gastrointestinal bleeding when compared with histamine H2-receptor antagonist.