Investigational study for the effect of some Proton Pump Inhibitors on the anticoagulant effect of Clopidogrel

Clopidogrel is a mainstay therapy in the cardiovascular (CVS) pharmacology for the prevention of the stent thrombosis and myocardial infarctions following many different types of coronary syndromes.The conversion of clopidogrel; which is a prodrug, to its active metabolite is mediated by the cytochrome P450 (CYP).The CYP450 metabolic activation of clopidogrel has proposed about if the competition and/or the inhibitor medications for these isoenzymes may reduce or limit the clopidogrel therapeutic effectiveness.The identification of such an impact will be of the higher importance with the group of drugs called the Proton Pump Inhibitors (PPIs) as many of which are CYPC19 inhibitors.Unless for the Omeprazole. Limited numbers of non-confirmed data were existed concerning the influence of the interaction between the other PPIs (such as Rabeprazole and Pantoprazole) and the therapeutic effectiveness of clopidogrel.This study sought to examine the effects of PPI’s pantoprazole and rabeprazole co-administered with clopidogrel in patients with ischemic heart disease and peripheral vascular disease. Our clinical research data show that platelet aggregation was significantly higher in patients who were under rabeprazoletreatment at the time of the platelet function test; on the other hand, such attenuating effect on the platelet response to clopidogrel was not seen in patients on pantoprazole.Till further evidence becomes available, patients on clopidogrel maintenance therapy should be reevaluated for PPI use. Those having well-controlled symptoms may be candidates for either Rabeprazole or pantoprazole. Patients with history of gastrointestinal bleed will require gastroprotection in the form of PPIs. In such cases, pantoprazole should be the preferred PPI.