Concomitant use of clopidogrel and PPIs after percutaneous coronary intervention acceptable

January 01, 0001

Concomitant use of clopidogrel and PPIs after percutaneous coronary intervention acceptable

The aim of the present study was to analyze the effect of drug exposure patterns of clopidogrel and proton pump inhibitors (PPIs) on the clinical outcomes after percutaneous coronary intervention (PCI). Previous analyses predominantly included discharge medications and did not explore the effect of the drug exposure patterns. The researchers from the US analyzed all-cause death, nonfatal myocardial infarction, repeat revascularization, and major adverse cardiovascular events (MACE) in a cohort of 23,200 post-PCI patients (January 2003 to December 2008) using a multivariate adjusted Cox model and propensity-matched case-control analysis.

The adjusted hazard ratio for MACE on PPI according to the exposure patterns of clopidogrel after PCI for 6 years was 1.24 and 1.12 for "continuous" (consistent clopidogrel with or without PPIs) and "switched" (clopidogrel with or without varying PPIs) respectively. However, the propensity score adjusted odds ratios for MACE on PPI use was 0.97 for "continuous" and 1.04 for "switched." Moreover, in the first year after PCI, the use of "rescue" (less than or equal to 30 days before MACE) nitroglycerin was greater in the patients taking clopidogrel and PPIs than in those taking clopidogrel alone, as was the overall use of rescue PPIs (significant).

The researchers concluded: "PPI use in clopidogrel- treated post-PCI patients was not associated with an increased risk of MACE after controlling for the confounding effect of PPI use with propensity matching. A potential for the misdiagnosis of angina symptoms and rescue use of nitroglycerin and PPIs in post-PCI patients exists, a finding that might have confounded previous observational analyses."

Important information for a common and increasingly common combination.

For the full abstract, click here.

American Journal of Cardiology published online 20 January 2011
© Elsevier, Inc.
Effect of Concomitant Use of Clopidogrel and Proton Pump Inhibitors After Percutaneous Coronary Intervention. Subhash Banerjee, Rick A. Weideman, Mark W. Weideman et al. Correspondence to Subhash Banerjee: Subhash.banerjee@va.govki

Category: K. Circulatory. Keywords: concomitant use, clopidogrel, proton pump inhibitors, PPIs, percutaneous coronary intervention, cohort study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 18 February 2011

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