Six-Month Outcomes With or Without Proton-Pump Inhibitors After Successful Pci: Insights From the Guthrie Pci Registry

Harjai, Kishore J.; Shenoy, Chetan; Orshaw, Pam; Boura, Judy; Rogers, Guy

doi:10.1016/s0735-1097(10)61676-2

Cited by 4 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1). One prospective randomized trial [23], two post-hoc analyses of randomized trials [11,24], 20 retrospective data analyses of cohort studies [13][14][15]18,21,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] and two case-control studies [18,43] included 159 138 patients (54 689 with PPIs and 104 449 without). Six studies were excluded: five studies without adjusted effect estimates and one study including the same patient population as another included study [16,17,19,22,44,45].…”

Section: Resultsmentioning

confidence: 99%

Effect of proton pump inhibitors on clinical outcome in patients treated with clopidogrel: a systematic review and meta‐analysis

Siller‐Matula

Jilma

Schrör

et al. 2010

Journal of Thrombosis and Haemostasis

119

View full text Add to dashboard Cite

To cite this article: Siller-Matula JM, Jilma B, Schrö r K, Christ G, Huber K. Effect of proton pump inhibitors on clinical outcome in patients treated with clopidogrel: a systematic review and meta-analysis. J Thromb Haemost 2010; 8: 2624-41.Summary. To investigate whether proton pump inhibitors (PPIs) negatively affect clinical outcome in patients treated with clopidogrel. Systematic review and meta-analysis. Outcomes evaluated were combined major adverse cardiac events (MACE), myocardial infarction (MI), stent thrombosis, death and gastrointestinal bleeding. Studies included were randomized trials or post-hoc analyzes of randomized trials and observational studies reporting adjusted effect estimates. Twenty five studies met the selection criteria and included 159 138 patients. Administration of PPIs together with clopidogrel corresponded to a 29% increased risk of combined major cardiovascular events [risk ratio (RR) = 1.29, 95% confidence intervals (CI) = 1.15-1.45] and a 31% increased risk of MI (RR = 1.31, 95%CI = 1.12-1.53). In contrast, PPI use did not negatively influence the mortality (RR = 1.04, 95%CI = 0.93-1.16), whereas the risk of developing a gastrointestinal bleed under PPI treatment decreased by 50% (RR = 0.50, 95% CI = 0.37-0.69). The presence of significant heterogeneity might indicate that the evidence is biased, confounded or inconsistent. The sensitivity analysis, however, yielded that the direction of the effect remained unchanged irrespective of the publication type, study quality, study size or risk of developing an event. Two studies indicate that PPIs have a negative effect irrespective of clopidogrel exposure. In conclusion, concomitant PPI use might be associated with an increased risk of cardiovascular events but does not influence the risk of death. Prospective randomized trials are required to investigate whether a cause-and-effect relationship truly exists and to explore whether different PPIs worsen clinical outcome in clopidogrel treated patients as the PPI-clopidogrel drug-drug interaction does not seem to be a class effect.

show abstract

Section: Resultsmentioning

confidence: 99%

Effect of proton pump inhibitors on clinical outcome in patients treated with clopidogrel: a systematic review and meta‐analysis

Siller‐Matula

Jilma

Schrör

et al. 2010

Journal of Thrombosis and Haemostasis

119

View full text Add to dashboard Cite

show abstract

“…Multiple retrospective analyses of clinical trial data, insurance database and registry data have reached disparate conclusions on the significance of the interaction on clinical outcomes. [29][30][31][32][33] In a retrospective analysis of 8205 Veterans Health Administration (VHA) hospital patients discharged following hospitalization for ACS, the receipt of a PPI was associated with an increase in the composite endpoint of death or rehospitalization for ACS in patients who received clopidogrel at discharge (29.8% vs. 20.8%, adjusted OR 1.25, 95% CI, 1.11-1.41). 34 The lone randomized study available for review is the COGENT study discussed earlier, which also evaluated the effect of omeprazole on cardiovascular outcomes in clopidogrel treated patients.…”

Section: Ppi-clopidogrel Interactionmentioning

confidence: 99%

Proton Pump Inhibitors and the Prevention of Recurrent GI Bleed in Patients Treated with Clopidogrel

Oyetayo

Farris

Wahawisan

2012

Clinical Medicine Insights: Therapeutics

View full text Add to dashboard Cite

Abstract:Clopidogrel is an antiplatelet agent indicated in the management of atherothrombotic conditions. Bleeding is a predictable adverse event associated with antiplatelet agents. While non-ulcerogenic; a major site of bleeding with clopidogrel is the gastrointestinal (GI) tract. The risk of GI bleeding with clopidogrel monotherapy is generally low; however, it increases with the presence of other risk factors such as aspirin use, advanced age, prior GI bleed, non-steroidal anti-inflammatory drugs, steroids and anticoagulants. In patients with a prior GI bleed, the risk of recurrence is high and strategies to prophylactically mitigate the risk should be implemented. In this review, evidence supporting the use of proton pump inhibitors to reduce the risk of recurrent GI bleed is discussed. Recommendations on an appropriate regimen to diminish the risk are provided.

show abstract

“…The GI bleed-reducing benefit of PPIs in patients using a DAT regimen was also highlighted in a recent retrospective cohort study by Ray et al 35 These researchers showed that concomitant use of PPI with clopidogrel in CAD is associated with fewer hospitalizations for gastrointestinal bleeds. Another recent retrospective review of PCI between 2001–2007 36 included a total of 2,646 patients on a DAT regimen after PCI and 28% of these patients were discharged on PPIs. In groups with or without PPI use, no differences in cardiovascular outcomes were noted.…”

Section: Introductionmentioning

confidence: 99%

The interaction between clopidogrel and proton pump inhibitors (PPI): is there any clinical relevance?

Sharma

Reddy²,

Sharma³

et al. 2010

CPAA

View full text Add to dashboard Cite

The potential interaction between clopidogrel and proton pump inhibitors (PPI) in patients with acute coronary syndrome (ACS) raises serious concerns for cardiologists. However, in patients on this combination of drugs, there is no conclusive evidence of an increase in adverse cardiovascular events. From pharmacologic and pharmacodynamic perspectives, there is a real interaction between clopidogrel and PPIs because of the competitive inhibition of CYP2C19 isoenzyme which is required for biotransformation of clopidogrel to its active metabolite. The consequent decrease in the availability of this active metabolite leads to attenuation of antiplatelet efficacy of clopidogrel. In several observational trials, it was shown that decreased antiplatelet effect of clopidogrel due to PPIs may translate into poor cardiovascular outcomes. However, an incomplete RCT (COGENT) and a post hoc analysis of two large trials (PRINCIPLE-TIMI 44 and TRITON-TIMI 38 trial) showed no significant adverse cardiovascular events with this combination. Caution is however needed in patients who are hypometabolizers of clopidogrel putting them at a higher risk of adverse coronary events. Since 3% of patients are likely to be hypometabolizers of clopidogrel, routine combination of clopidogrel and PPIs should be avoided. There is a heightened awareness of this interaction following multiple advisory warnings. At the same time, one should not withhold PPIs in patients who are at a high risk of developing gastrointestinal (GI) bleeding. In these patients, selected choices of PPI such as pantoprazole may be helpful and for low risk patients, serious consideration should be given to H2 receptor antagonists or antacids. Therefore, while not compromising the cardioprotective effect of antiplatelet agents, the gastroprotective benefit of PPI should be strongly considered in patients who need both. Health care providers should remain alert to more outcome data. Future researchers will need to demonstrate the safety of coadministration of PPIs and clopidogrel and trials should be powered to detect major adverse cardiovascular events and facilitate risk stratification based on genetic polymorphism.

show abstract

Six-Month Outcomes With or Without Proton-Pump Inhibitors After Successful Pci: Insights From the Guthrie Pci Registry

Cited by 4 publications

References 0 publications

Effect of proton pump inhibitors on clinical outcome in patients treated with clopidogrel: a systematic review and meta‐analysis

Effect of proton pump inhibitors on clinical outcome in patients treated with clopidogrel: a systematic review and meta‐analysis

Proton Pump Inhibitors and the Prevention of Recurrent GI Bleed in Patients Treated with Clopidogrel

The interaction between clopidogrel and proton pump inhibitors (PPI): is there any clinical relevance?

Contact Info

Product

Resources

About