Outcomes with concurrent use of clopidogrel and proton-pump inhibitors

January 01, 0001

Outcomes with concurrent use of clopidogrel and proton-pump inhibitors

These US authors examined the association between concurrent use of proton-pump inhibitors (PPIs) and clopidogrel and the risks for hospitalizations for gastroduodenal bleeding and serious cardiovascular disease in a retrospective cohort study. They used automated data to identify patients who received clopidogrel between 1999 through 2005 after hospitalization for coronary heart disease in a data base of 20,596 patients (including 7593 concurrent users of clopidogrel and PPIs) hospitalized for myocardial infarction, coronary artery revascularization, or unstable angina pectoris.

They found: "Pantoprazole and omeprazole accounted for 62% and 9% of concurrent PPI use, respectively. Adjusted incidence of hospitalization for gastroduodenal bleeding in concurrent PPI users was 50% lower than that in nonusers (hazard ratio 0.50). For patients at highest risk for bleeding, PPI use was associated with an absolute reduction of 28.5 hospitalizations for gastroduodenal bleeding per 1000 person-years. The hazard ratio associated with concurrent PPI use for risk for serious cardiovascular disease was 0.99 for the entire cohort and 1.01 for the subgroup of patients who had percutaneous coronary interventions with stenting during the qualifying hospitalization."

The authors concluded: "In patients with serious coronary heart disease treated with clopidogrel, concurrent PPI use was associated with reduced incidence of hospitalizations for gastroduodenal bleeding. The corresponding point estimate for serious cardiovascular disease was not increased; however, the 95% CI included a clinically important increased risk."

Best to avoid the combination if possible, but these data add weight to the evidence that preventing GI bleeding is a real benefit with concurrent use of PPIs.

For the full abstract, click here.

Annals of Internal Medicine Volume+issue 152( 6):337-345, 16 March 2010
© 2010 to the American College of Physicians
Outcomes With Concurrent Use of Clopidogrel and Proton-Pump Inhibitors-A Cohort Study. Wayne A. Ray, Katherine T. Murray, Marie R. Griffin, et al. Correspondence to Dr. Wayne Ray: [email protected]

Category: K. Circulatory, D. Digestive. Keywords: clopidogrel, proton pump inhibitors, PPIs, bleeding, cardiovascular events, cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 30 March 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.