Abstract 16319: 13C Pantoprazole Breath Test Can Predict the Antiplatelet Effect of Clopidogrel After 300mg Loading
Background: Clopidogrel, a P2Y12 ADP receptor blocker, is essential for antiplatelet therapy after coronary stent implantation. Clopidogrel is a prodrug that is activated by CYP families and most influenced by CYP2C19. Weaker antiplatelet effect of clopidogrel and more cardiovascular event were reported in the population of function-reduced polymorphisms(CYP2C19*2 and *3). Pantoprazole is also metabolized by CYP2C19. In a recent report, 13C-pantoprazole breath test can evaluate the activity of CYP2C19 rapidly. Aim: To evaluate the efficacy of 13C-pantoprazole breath test as the predictor of the antiplatelet effect of clopidogrel.
Methods and Results: Twenty-seven healthy volunteers underwent 13C-pantoprazole breath test and we analyzed their CYP2C19 polymorphisms. The changes in the carbon isotope ratios (13CO2 /12CO2) in expiration gas were measured before and after taking 13C-pantoprazole, and expressed as a delta over baseline (DOB) ratio (<924>). All subjects took clopidogrel 300mg loading dose at first day and 75mg maintenance dose at 2nd and 3rd day. Platelet function estimated by inhibition of platelet aggregation(IPA) was analyzed at baseline, 24 h and 48 h after clopidogrel loading. In our study population, there were 13 extensive metabolizers(EMs),10 intermediate metabolizers(IMs), and 4 poor metabolizers(PMs). The DOB values were significantly lower in PMs groups than other(P<0.0001 figure). The area under the curve(AUC) of the DOB was significantly correlated with IPA(ADP 20 μ) at 48h after clopidogrel loading(γ=0.58 P=0.0023).
Conclusions:13C pantoprazole breath test can screen PMs and predict antiplatelet effect of clopidogrel rapidly.
- © 2010 by American Heart Association, Inc.