Do proton pump inhibitors adversely affect the therapeutic action of clopidogrel?

Reference
Ho PM, et al. Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome. JAMA. 2009 Mar 4;301(9):937-44.

Objective
To assess outcomes of patients taking clopidogrel with or without a proton pump inhibitor (PPI) after hospitalization for acute coronary syndrome (ACS)

Methods
Retrospective cohort study of 8,205 patients with ACS taking clopidogrel after hospital discharge; followed for median 521 days; compared patients with vs. without proton pump inhibitor prescription; 63.9% prescribed proton pump inhibitors at hospital discharge or during follow-up. Patients prescribed proton pump inhibitor were significantly older and had more comorbid conditions (Table 1, p. 939).

Data
Table 2 shows incident rates for outcomes in patients prescribed PPI versus those without prescription
Rehospitalization for acute coronary syndrome: 14.6%(with PPI) vs. 6.9% (without PPI)
Revascularization procedures: 15.5% vs. 11.9%
All-cause death in 19.9% vs. 16.6% (not statistically significant)

A figure compares risk for all-cause mortality and recurrent ACS among patients on PPI/no clopidogrel, neither medication, clopidogrel/no PPI, and clopidogrel/PPI

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About Amy

Clinical Informationist at EUH Branch Library
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