Omeprazole-clopidogrel interaction and neurovascular complications after flow-diverter device placement

Authors

Joshua S. Catapano, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Visish M. Srinivasan, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Andre A. Wakim, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Jaclyn N. Lundberg, Department of General Medicine, Creighton University School of Medicine, Phoenix Health Sciences Campus, Phoenix, Arizona, USA.
Caleb Rutledge, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Tyler S. Cole, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Jacob F. Baranoski, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Vance L. Fredrickson, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Redi Rahmani, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Felipe C. Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Andrew F. Ducruet, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA neuropub@barrowneuro.org.

Document Type

Article

Abstract

BACKGROUND: Omeprazole is a common proton pump inhibitor that interferes with the hepatic activation of clopidogrel and potentially reduces its platelet-inhibitory effect. Omeprazole has been shown to increase P2Y levels and adverse cardiovascular outcomes in patients treated with drug-eluting stents. However, omeprazole use among patients treated with flow-diverting stents for intracranial aneurysms has not been evaluated. METHODS: All patients with placement of a flow-diverting device for treatment of an intracranial aneurysm at a tertiary institution from January 1, 2014, to December 31, 2018, were retrospectively analyzed. Inclusion criteria included documented clopidogrel administration, available P2Y levels, and thorough documentation of administration of other medications, including omeprazole. RESULTS: A total of 138 patients met the inclusion criteria. Sixteen patients (12%) were receiving omeprazole and clopidogrel at treatment. P2Y reactivity was significantly greater in the omeprazole cohort (mean P2Y level, 250 P2Y reaction units (PRU)) than in the control cohort (mean P2Y level, 112PRU) (P<0.001). Furthermore, a greater proportion of patients had a P2Y level >180 PRU in the omeprazole cohort (14 of 16 [88%] vs 24 of 122 [20%]; P<0.001; OR [95% CI], 29 [6-134]). CONCLUSION: Omeprazole was associated with a significant increase in the mean P2Y reactivity level among patients with intracranial aneurysms treated with flow-diverting devices who received clopidogrel. However, receipt of omeprazole was not associated with an increased risk of ischemic events or stent stenosis. For neuroendovascular patients who are treated with a flow diverter while receiving clopidogrel, alternative gastrointestinal medication regimens should be considered.

Medical Subject Headings

Blood Platelets; Clopidogrel; Humans; Omeprazole (adverse effects); Platelet Aggregation Inhibitors (therapeutic use); Retrospective Studies

Publication Date

4-1-2022

Publication Title

Journal of neurointerventional surgery

E-ISSN

1759-8486

Volume

14

Issue

4

First Page

380

Last Page

383

PubMed ID

34083398

Digital Object Identifier (DOI)

10.1136/neurintsurg-2021-017397

Recommended Citation

Catapano, Joshua S.; Srinivasan, Visish M.; Wakim, Andre A.; Lundberg, Jaclyn N.; Rutledge, Caleb; Cole, Tyler S.; Baranoski, Jacob F.; Fredrickson, Vance L.; Rahmani, Redi; Albuquerque, Felipe C.; and Ducruet, Andrew F., "Omeprazole-clopidogrel interaction and neurovascular complications after flow-diverter device placement" (2022). Translational Neuroscience. 2275.
https://scholar.barrowneuro.org/neurobiology/2275