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