In diabetic CAD patients, Omeprazole increased mean PRU by 18.4 (10.2%, p=0.002) and raised Clopidogrel non-responders from 44% to 56%, with 25% responders becoming non-responders.
Does omeprazole increase platelet reactivity in diabetic patients with CAD on aspirin and clopidogrel?
In diabetic patients with CAD, adding omeprazole to clopidogrel and aspirin significantly increases platelet reactivity and the rate of clopidogrel non-responders.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background Proton pump inhibitors (PPIs) are commonly prescribed alongside Aspirin and Clopidogrel to reduce the risk of gastrointestinal bleeding. However, the latest European Society of Cardiology (ESC) diabetes guidelines recommend against the concomitant use of Omeprazole and Clopidogrel due to potential drug interactions that may reduce Clopidogrel’s antiplatelet effect. Despite this warning, resource-limited settings such as Thailand continue to widely use this combination, even among diabetic populations. The applicability of this recommendation in Thailand remains uncertain, warranting further investigation. Objective To assess platelet function, specifically platelet reactivity measured as P2Y12 reaction units (PRU), in diabetic patients on Aspirin and Clopidogrel with or without Omeprazole using the VerifyNow P2Y12 assay. Methods A double-blind, randomised, placebo-controlled cross-over trial was conducted in diabetic patients with coronary artery disease (CAD) on Aspirin 81 mg/day and Clopidogrel 75 mg/day without Omeprazole for over two weeks. Participants were randomised to receive either Omeprazole 20 mg daily or a placebo for two weeks, followed by a crossover for another two weeks. PRU was assessed at baseline, two weeks, and post-crossover. The primary outcome was the mean PRU change between Omeprazole and placebo. Secondary outcomes included changes in Clopidogrel responder status (non-responder: PRU 208) Results: Between August 2024 and January 2025, 50 patients were enrolled in this study. All of them had hypertension and dyslipidaemia. The time since events or revascularisation was 7 months (IQR 2–14), and age was 67 years (IQR 60–67). 58 % were male, with an HbA1c of 6.7% (IQR 6.4–8.1). No significant carryover effects were observed. Omeprazole co-administration significantly increased mean PRU by 18.4 (10.2%, p = 0.002) compared to baseline. The adjusted mean PRU still showed a rise of 20.7 (p = 0.002). The number of Clopidogrel non-responders increased from 22 (44%) to 28 (56%) after Omeprazole use, with 7 (25%) of responders transitioning to non-responders. Higher BMI was significantly associated with an increased likelihood of non-responder status (OR = 1.3, p = 0.02). Conclusions In diabetic patients, a high proportion were non-responders prior to Omeprazole administration, and one-quarter of the initial responders transitioned to non-responder status. Therefore, Clopidogrel and Omeprazole should be avoided in this setting. However, if use is necessary, screening for Clopidogrel response status is recommended before co-prescription, and close monitoring is advised.Difference means PRU change among group Responder status change
Thungthienthong et al. (Sat,) reported a other. In diabetic CAD patients, Omeprazole increased mean PRU by 18.4 (10.2%, p=0.002) and raised Clopidogrel non-responders from 44% to 56%, with 25% responders becoming non-responders.