관상동맥 스텐트 삽입술 시행 후 Clopidogrel 기반 이중 항혈소판 치료를 받는 환자에서 Esomeprazole과 Tegoprazan 병용 및 심혈관계 사건 발생 비교
Co-administration of Clopidogrel-based DAPT and Antisecretory Agents: Comparison of Incidence of Cardiovascular Events
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Background : Patients who have undergone percutaneous coronary intervention (PCI) receive clopidogrel-based dual antiplatelet therapy (DAPT) to prevent complications. Concurrent administration of proton pump inhibitors (PPI) is common to prevent gastrointestinal side effects associated with this therapy. While esomeprazole, a substrate for CYP2C19, inhibits the conversion of clopidogrel to its active form, tegoprazan, primarily metabolized by CYP3A4, provides a potential advantage. Therefore, this study aims to compare the incidence rate of cardiovascular events between esomeprazole and tegoprazan in patients receiving clopidogrel-based DAPT after PCI at a tertiary hospital. Methods : This retrospective study analyzed the electronic medical records of patients prescribed aspirin, clopidogrel, and antisecretory agents, following PCI, between June 2019 and May 2022, at Severance Hospital. A 12 month follow-up post-PCI was conducted to compare the incidence of cardiovascular events in both groups, including myocardial infarction, stroke, revascularization, and death. Results : Of the 149 patients, 40 received esomeprazole, while 109 received tegoprazan. The median duration of concomitant drug use was 352.0 days (interquartile range [IQR] 247.8-356.0) in the esomeprazole group, and 348.0 days (IQR 246.5−354.5) in the tegoprazan group, with no significant difference (p=0.10). The incidence of cardiovascular events did not differ significantly between the two groups (5.0 vs. 2.8 %, p=0.61). Conclusion : This study found no significant difference in the incidence of cardiovascular events between the esomeprazole and tegoprazan groups among patients receiving clopidogrel-based DAPT post-PCI. However, considering the limitations in the small-scale retrospective nature of this study, further prospective research is recommended.
Abstract
Background : Patients who have undergone percutaneous coronary intervention (PCI) receive clopidogrel-based dual antiplatelet therapy (DAPT) to prevent complications. Concurrent administration of proton pump inhibitors (PPI) is common to prevent gastrointestinal side effects associated with this therapy. While esomeprazole, a substrate for CYP2C19, inhibits the conversion of clopidogrel to its active form, tegoprazan, primarily metabolized by CYP3A4, provides a potential advantage. Therefore, this study aims to compare the incidence rate of cardiovascular events between esomeprazole and tegoprazan in patients receiving clopidogrel-based DAPT after PCI at a tertiary hospital. Methods : This retrospective study analyzed the electronic medical records of patients prescribed aspirin, clopidogrel, and antisecretory agents, following PCI, between June 2019 and May 2022, at Severance Hospital. A 12 month follow-up post-PCI was conducted to compare the incidence of cardiovascular events in both groups, including myocardial infarction, stroke, revascularization, and death. Results : Of the 149 patients, 40 received esomeprazole, while 109 received tegoprazan. The median duration of concomitant drug use was 352.0 days (interquartile range [IQR] 247.8-356.0) in the esomeprazole group, and 348.0 days (IQR 246.5−354.5) in the tegoprazan group, with no significant difference (p=0.10). The incidence of cardiovascular events did not differ significantly between the two groups (5.0 vs. 2.8 %, p=0.61). Conclusion : This study found no significant difference in the incidence of cardiovascular events between the esomeprazole and tegoprazan groups among patients receiving clopidogrel-based DAPT post-PCI. However, considering the limitations in the small-scale retrospective nature of this study, further prospective research is recommended.
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