Impact of ranitidine on platelet aggregation in patients taking clopidogrel

Impact of ranitidine on platelet aggregation in patients taking clopidogrel Prophylaxis of gastrointestinal bleeding is often used in patients taking dual antiplatelet therapy (DAT) with aspirin and clopidogrel. However, proton-pump inhibitors (PPIs), especially omeprazole, have been associated with clopidogrel resistance, and ranitidine has been suggested as a safe alternative. Nevertheless, very little is known about the role of ranitidine utilization in patients on DAT, regarding platelet aggregation. Purpose: The main purpose of this study was to analyze the role of ranitidine utilization in patients on DAT. Methods: We analyzed 121 patients: 68 patients were included prospectively in a routine basis in a databank from a tertiary center CCU (55 patients taking ranitidine and 13 without any prophylaxis of gastrointestinal bleeding). The remaining 53 patients were enrolled from an ongoing research protocol (in which no patient was taking prophylaxis of gastrointestinal bleeding because of protocol constraints). The groups were similar among them regarding baseline characteristics, and all population was on DAT. The patients were then separated by the use or not of ranitidine and subsequently compared for platelet aggregation. Platelet aggregation was analyzed using the VerifyNow P2Y12 point of care system, and its values expressed in P2Y12 Reaction Units (PRU), with a PRU ≥ 230 being defined as resistance to clopidogrel. Results: Of the 121 patients analyzed, 66 of them were not using any medication for gastrointestinal bleeding prophylaxis (Group 1) and 55 were on ranitidine 150 mg twice a day (Group 2). The mean P2Y12-mediated platelet reactivity to ADP assessed by PRU is depicted in Table 1. As can be seen, no significant difference was demonstrated between the groups. View this table: Table 1. The mean P2Y12-mediated platelet reactivity to ADP assessed by PRU in patients on DAT not taking (Group 1) or taking ranitidin (Group 2) for gastrointestinal bleeding prophylaxis Conclusions: The use of ranitidine does not interfere with platelet aggregation in patients on DAT.