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

• DOI: 10.1161/circulationaha.109.873497
• Publication Date: 2009-11-24T04:09:28Z
• Authors: Jeremy A. Rassen; Niteesh K. Choudhry; Jerry Avorn; Sebastian Schneew...
• Keywords: Clinical endpoint

Recent studies have raised concerns about the reduced efficacy of clopidogrel when used concurrently with proton pump inhibitors (PPIs), but those may overestimated risk.We studied potential for increased risk adverse cardiovascular events among users versus without concurrent use PPIs in 3 large cohorts patients > or =65 years age, treated between 2001 and 2005. All had undergone percutaneous coronary intervention been hospitalized acute syndrome Pennsylvania, New Jersey, British Columbia, subsequently initiated treatment clopidogrel. We recorded myocardial infarction hospitalization, death, revascularization PPI nonusers. assessed our primary end point hospitalization death using cohort-specific pooled regression analyses. entered 18 565 into analysis. On a basis, 2.6% who also 2.1% nonusers hospitalization; 1.5% 0.9% died; 3.4% 3.1% underwent revascularization. The propensity score-adjusted rate ratio was 1.22 (95% confidence interval, 0.99 to 1.51); 1.20 0.84 1.70); revascularization, 0.97 0.79 1.21). Matched analyses generally yielded similar results.Although estimates indicated slightly older initiating both PPI, we did not observe conclusive evidence clopidogrel-PPI interaction major clinical relevance. Our data suggest that if this effect exists, it is unlikely exceed 20% increase.