Dirk Sibbing Discusses Understanding on Drug-Drug Interactions of Antiplatelet Agents
New Hot Paper Commentary, September 2010
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Article: Impact of proton pump inhibitors on the antiplatelet effects of clopidogrel
Authors: Sibbing, D;Morath, T;Stegherr,
J;Braun, S;Vogt, W;Hadamitzky, M;Schomig, A;Kastrati, A;von
Beckerath, N |
Dirk Sibbing talks with ScienceWatch.com and answers a few questions about this month's New Hot Papers paper in the field of Clinical Medicine.
Why do you think your paper is highly
cited?
During the past decade, more and more people with coronary artery disease are being treated with coronary stent placement worldwide. Once a coronary stent has been implanted these patients highly depend on an adequate response to dual antiplatelet treatment with aspirin and a thienopyridine derivative such as clopidogrel. Proton pump inhibitors (PPIs), commonly co-prescribed in these patients, attenuate the antiplatelet action of clopidogrel. But as our Thrombosis & Haemostasis paper shows, not all of them do so.
I believe that this paper is so highly cited because it compared a number of different PPIs in terms of their impact on clopidogrel responsiveness and clearly described that some PPIs interact with clopidogrel whereas others do not. Thereby, it may help the clinician on deciding which PPIs to take and which to avoid in the setting of antiplatelet treatment.
Does it describe a new discovery, methodology, or
synthesis of knowledge?
"I believe and hope that many lives will be saved in the future through a better and individualized antiplatelet treatment in patients with coronary stent placement"
Basically, it describes a new discovery as it shows that the negative impact of PPIs on the antiplatelet action of clopidogrel is not a class effect inherent to all PPIs. Moreover, it used a novel technology of platelet function testing called Multiplate, which is now—based on the results of this paper and further studies from our group and others—a routine method in our clinic and some other centers worldwide.
Would you summarize the significance of your paper
in layman's terms?
We now have a better understanding on drug-drug interactions of antiplatelet agents, those drugs desperately needed to treat patients with coronary stent placement, and proton pump inhibitors that shall protect from side effects of antiplatelet agents such as heartburn disease and gastric ulcers.
How did you become involved in this research, and
how would you describe the particular challenges, setbacks, and
successes that you've encountered along the way?
Research on antiplatelet agents in the setting of percutaneous coronary intervention (PCI) has always been of focus of research in our center in Munich. In recent years, the ISAResearch group has done a number of studies that really changed and improved treatment of patients. I am proud to be part of it and thankful to my mentors, Professor Schömig, Professor Kastrati and Professor von Beckerath, who gave me the chance to conduct my own studies very early in my career.
Where do you see your research leading in the
future?
Although numerous studies have been successfully conducted in this field, so much remains to be discovered: Why do some patients bleed during or after coronary stenting whereas others suffer thrombotic events such as stent thrombosis? How may genetic factors impact the outcome of patients and does knowing the genetic background help to avoid complications in the end?
Do you foresee any social or political
implications for your research?
I believe and hope that many lives will be saved in the future through a
better and individualized antiplatelet treatment in patients with coronary
stent placement. For my future research I hope that it will help to guide
and optimize antiplatelet treatment in patients undergoing coronary
stenting, who desperately depend on a good response to their individual
antiplatelet treatment prescribed.
Dr. med. Dirk Sibbing
Member of the ISAResearch Center
Director of Platelet Function Lab
Deutsches Herzzentrum München
Klinik an der Technischen Universität
München
München, Germany
KEYWORDS: CLOPIDOGREL; PROTON PUMP INHIBITORS; PLATELET AGGREGATION; PERCUTANEOUS CORONARY INTERVENTION; MULTIPLE ELECTRODE AGGREGOMETRY; ELUTING STENT THROMBOSIS; PLATELET-AGGREGATION; ARTERY-DISEASE; CLINICAL-IMPLICATIONS; WHOLE-BLOOD; 600 MG; PHARMACOKINETICS; REACTIVITY.