Cardiovascular Outcomes and Mortality in Patients Using Clopidogrel With Proton Pump Inhibitors After Percutaneous Coronary Intervention or Acute Coronary Syndrome

被引:210
作者
Rassen, Jeremy A. [1 ]
Choudhry, Niteesh K.
Avorn, Jerry
Schneeweiss, Sebastian
机构
[1] Harvard Univ, Brigham & Womens Hosp, Div Pharmacoepidemiol & Pharmacoecon, Dept Med,Med Sch, Boston, MA 02120 USA
基金
美国医疗保健研究与质量局; 美国国家卫生研究院;
关键词
clopidogrel; drugs; myocardial infarction; platelets; proton pump inhibitors; revascularization; ACUTE MYOCARDIAL-INFARCTION; ST-SEGMENT ELEVATION; ANTIPLATELET ACTION; CONTROLLED TRIAL; ASPIRIN; THERAPY; RISK; RESISTANCE; EVENTS; DRUGS;
D O I
10.1161/CIRCULATIONAHA.109.873497
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Recent studies have raised concerns about the reduced efficacy of clopidogrel when used concurrently with proton pump inhibitors (PPIs), but those studies may have overestimated the risk. Methods and Results-We studied the potential for increased risk of adverse cardiovascular events among users of clopidogrel with versus without concurrent use of PPIs in 3 large cohorts of patients >= 65 years of age, treated between 2001 and 2005. All patients had undergone percutaneous coronary intervention or had been hospitalized for acute coronary syndrome in Pennsylvania, New Jersey, or British Columbia, and subsequently had initiated treatment with clopidogrel. We recorded myocardial infarction hospitalization, death, and revascularization among PPI users and nonusers. We assessed our primary end point of myocardial infarction hospitalization or death using cohort-specific and pooled regression analyses. We entered 18 565 clopidogrel users into our analysis. On a pooled basis, 2.6% of those who also initiated a PPI versus 2.1% of PPI nonusers had a myocardial infarction hospitalization; 1.5% versus 0.9% died; and 3.4% versus 3.1% underwent revascularization. The propensity score-adjusted rate ratio for the primary end point of myocardial infarction or death was 1.22 (95% confidence interval, 0.99 to 1.51); for death, 1.20 (95% confidence interval, 0.84 to 1.70); and for revascularization, 0.97 (95% confidence interval, 0.79 to 1.21). Matched analyses generally yielded similar results. Conclusions-Although point estimates indicated a slightly increased risk of myocardial infarction hospitalization or death in older patients initiating both clopidogrel and a PPI, we did not observe conclusive evidence of a clopidogrel-PPI interaction of major clinical relevance. Our data suggest that if this effect exists, it is unlikely to exceed a 20% risk increase. (Circulation. 2009; 120: 2322-2329.)
引用
收藏
页码:2322 / U34
页数:11
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