관상동맥 스텐트 삽입술을 시행한 환자에서 Omeprazole과의 병용이 Clopidogrel의 효능에 미치는 영향

Abstract

Clopidogrel is converted to an active metabolite by hepatic cytochrome P450 isoenzymes,with cytochrome P450 2C19 (CYP2C19) playing a major role. Because omeprazole is the main substrate of this enzyme, the concomitant use of clopidogrel and omeprazole is associated with reduced plasma concentration of clopidogrel. However, there has been no definite conclusion yet to whether this drug-drug interaction results in significant clinical outcomes, such as cardiovascular events. Further, the expression rate of CYP2C19, which is a poor metabolizer, in Koreans is higher than in Caucasians. So this trial sought to assess the influence of omeprazole on clopidogrel efficacy in Korean patients. We conducted a retrospective study, among patients who received aspirin clopidogrel, following coronary artery stent insertion, between January 1, 2000, and December 31, 2008. ㄴWe performed a follow-up for a year after the surgical procedure and divided patients into two groups,the clopidogrel with omeprazole group (experimental group) and the clopidogrel alone group (control group). The former were 39 patients who take this combination therapy for more than a week, and the latter (at a ratio of 2:1) comprised of 65 patients that were matched to patients had with the same age, same sex, and no PPI history during the follow-up period. Date difference in the surgical procedure is within a year between the matched patients. We regarded the impact of omeprazole on clopidogrel efficacy as the frequency of the cardiovascular events, which are Major Adverse Cardiac Events and Stent Restenosis in Coronary Angiogram, during the follow-up period. Higher frequency appeared of these events in the clopidogrel,with omeprazole group, than in the clopidogrel alone group. However, there was no significant difference between the two groups. (35.9% vs 29.2%, p=0.48)In our study, co-administration of clopidogrel and omeprazole showed a negative effect on clopidogrel’s efficacy, but the result did not show statistical significance. Thereafter, a prospective study should be done in more patients in the near future.