Proton pump inhibitors (PPIs) have been recommended for reducing the risk of gastrointestinal bleeding associated with dual antiplatelet therapy (aspirin plus clopidogrel). However, studies have found decreased efficacy of clopidogrel when concurrently administered with a PPI. To determine the mechanism of and evidence for the potential interaction between clopidogrel and PPIs, along with the clinical implications of this drug interaction, we reviewed recently published reports of trials that examined the interaction. A MEDLINE database search (1966-September 2009) for English-language reports of clinical trials in human subjects was performed, supplemented by a manual search of reference lists. Four trials that examined surrogate outcomes and eight trials that examined clinical outcomes were included in this review. Two surrogate outcome studies showed that PPIs negatively affected clopidogrel response and increased platelet aggregation, whereas the other two did not find a significant difference between groups receiving PPIs and not receiving PPIs. Three of four published clinical outcomes studies and three of four unpublished clinical outcomes studies available as abstracts found a significant association between PPI use and rates of acute myocardial infarction, rehospitalization, death, or stroke. Most of the currently available data, primarily from observational studies, show that some PPIs may decrease clopidogrel's antiplatelet effectiveness, with increased cardiac adverse outcomes when clopidogrel is combined with PPIs. Although current data do not show causation of adverse outcomes with PPI use because the available data are conflicting, this topic is still controversial. Careful risk-benefit assessment is required before prescribing PPIs for individual patients taking dual antiplatelet therapy. More evidence from randomized controlled trials is needed to clarify this drug interaction dilemma.

Drug Interaction Between Clopidogrel and Proton Pump Inhibitors

Enhanced platelet reactivity and thrombosis in Apoe-/- mice exposed to cigarette smoke is attenuated by P2Y12 antagonism.

Resume
Plusieurs travaux ont montre une mortalite paradoxalement plus faible chez les fumeurs ayant beneficie d’une thrombolyse a la phase aigue de l’infarctus du myocarde (IDM) comparativement aux non-fumeurs. Ce « paradoxe des fumeurs » a ete par ailleurs peu etudie en cas d’angioplastie primaire.
But du travail
Etudier l’impact du tabagisme sur la mortalite a 30 jours des patients admis pour un IDM selon la strategie de reperfusion.
Patients et methodes
Etude realisee a partir du registre des IDM avec sus-decalage ST incluant 688 patients ayant beneficie, soit d’une thrombolyse hospitaliere ou prehospitaliere (n = 397) ou d’une angioplastie primaire (n = 291). Parmi ces patients, 482 (70,1 %) etaient des fumeurs actifs.
Resultats
Dans le groupe thrombolyse, la prevalence de l’hypertension arterielle, du diabete et des IDM anterieurs etait significativement plus faible chez les patients tabagiques. Dans le groupe angioplastie primaire, le diabete et l’hypertension arterielle etaient moins frequents. La mortalite a j30 des patients tabagiques etait significativement plus faible chez les fumeurs en cas de thrombolyse comparativement aux non-fumeurs (5,3 vs 13 % ; p = 0,008). En analyse multivariee, l’etat de choc (p < 0,0001), l’IDM anterieur (p = 0,03) et le tabagisme actif (p = 0,03) etaient des facteurs predictifs de mortalite en cas de thrombolyse. Dans le groupe des patients ayant beneficie d’une angioplastie primaire, la mortalite des fumeurs avait une tendance a etre plus faible (10 vs 17,6 % ; p = 0,07).
Conclusion
« Le paradoxe des fumeurs » semble etre observe principalement chez les patients ayant beneficie d’une thrombolyse.

« Paradoxe des fumeurs » et stratégie de reperfusion à la phase aiguë de l’infarctus du myocarde

Background For decades, cardiovascular diseases (CVD) have been known as men's disease. However, recent research studies showed that they have become more common in women. Smoking is a strong risk factor for CVD especially that of coronary artery disease (CAD). Several studies reported that women are more susceptible to drastic sequels of smoking than men. There is limited data regarding the impact of smoking on post-revascularization clinical events stratified by gender. This study aimed to investigate if gender significantly changes the incidence of adverse clinical outcomes after percutaneous coronary intervention (PCI) among those with history of smoking. Methods Participants were selected from two hospitals from 2003 to 2019. Among patients who had PCI (index PCI), those with stable CAD who underwent elective PCI were included. Exclusion criteria were defined as primary PCI and those with multiple prior revascularizations. Participants were followed up seeking for major adverse cardiac events (MACE) including revascularization (PCI or coronary artery bypass grafting), myocardial infarction, and coronary death in three time intervals according to the time of index PCI (short term: up to 24 hours, mid-term: 24 hours to less than 6 months, and long term: more than 6 months). Results Of the 1799 patients, 61% were men and 47.08% had history of smoking (75% of the smokers were men). At the time of index PCI, smokers were significantly younger than nonsmokers. Also, MACE were significantly higher in smokers than nonsmokers, which was particularly pronounced at the long-term interval. In the nonsmokers group, there was no difference in MACE occurrence between men and women. However, of the smokers, women showed significantly higher MACE rate compared with men peers. Conclusion Smoking makes women more prone to MACE in comparison to men among patients with stable CAD after PCI with drug-eluting stent.

/pdf/the-impact-of-smoking-on-clinical-outcomes-after-4qvb8u55pa.pdf

The Impact of Smoking on Clinical Outcomes after Percutaneous Coronary Intervention in Women Compared to Men.

Differences in the mode of presentation for acute coronary syndrome by pre-hospitalization medication, in relation to coronary risk factors, East-Osaka acute coronary syndrome (EACS) registry.

Clopidogrel but not Aspirin prevents acute smoking-induced platelet aggregation in patients with stable coronary artery disease.

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Clopidogrel but not Aspirin prevents acute smoking-induced platelet aggregation in patients with stable coronary artery disease.