Cardiovascular outcomes associated with concomitant use of clopidogrel and proton pump inhibitors in patients of acute coronary syndrome in taiwan
British Journal of Clinical Pharmacology, 05/07/2012
Lin CF et al. – This study indicated no statistically significant increase in the risk of rehospitalization for ACS due to concurrent use of clopidogrel and PPIs overall. Among individual PPIs, only omeprazole was found to be statistically significantly associated with increased risk of rehospitalization for ACS.Methods
- Authors conducted a retrospective cohort study of patients who were newly hospitalized for ACS during 1 January 2006 and 31 December 2007 retrieved from the Taiwan National Health Insurance Research Database (NHIRD) and were prescribed clopidogrel (n = 37099) during the followed–up period.
- Propensity score technique was used to establish a matched cohort in 1:1 ratio (n = 5173 for each group).
- The primary clinical outcome was rehospitalization for ACS and secondary outcomes were rehospitalization for percutaneous transluminal coronary angioplasty (PTCA) with stent, PTCA without stent, and revascularization (PTCA or coronary artery bypass graft surgery) after the discharge date for the index ACS event.
- The adjusted hazard ratio (HR) of rehospitalization for ACS was 1.052 (95% confidence interval (CI) l, 0.971–1.139, p = 0.214) in the propensity score matched cohort.
- Among all PPIs, only omeprazole was found to be statistically significantly associated with an increased risk of rehospitalization for ACS (adjusted HR, 1.226; 95% CI, 1.066–1.410, p = 0.004).
- Concomitant use of esomeprazole, pantoprazole, rabeprazole, and lansoprazole did not increase the risk.