Adverse cardiovascular effects of concomitant use of proton pump inhibitors and clopidogrel in patients with coronary artery disease: a systematic review and meta-analysis
Archives of Medical Research, 06/15/2012
Evidence Based Medicine
Huang B et al. – Concomitant use of PPIs and clopidogrel in patients with coronary artery disease is associated with an increased risk of MACE or acute coronary syndrome, but there is insufficient evidence to conclude that there is an interaction between individual PPIs and clopidogrel.Methods
- A systematic electronic literature search was conducted in EMBASE, MEDLINE, PubMed and Chinese Biomedical Literature Database (CBM) to identify the studies reporting on the association of concomitant use of PPIs and clopidogrel with adverse cardiovascular outcomes.
- A hand search of reference lists was performed to identify further studies.
- Only studies published in English or Chinese were included in this review.
- Twenty seven full–text articles and five s with 159,998 patients were included in meta–analysis.
- Concomitant use of PPIs and clopidogrel is associated with an increased risk of major cardiovascular events (MACE) (HR 1.40, 95% CI 1.19–1.64; OR 1.27, 95% CI 1.13–1.42) and acute coronary syndrome (HR 1.42, 95% CI 1.14–1.77; OR 1.42, 95% CI 1.08–1.87) but not with all–cause mortality (HR 1.30, 95% CI 0.91–1.86; OR 0.92, 95% CI 0.82–1.04), cardiovascular death (HR 1.21, 95% CI 0.60–2.43) and stent thrombosis (HR 1.52, 95% CI 0.87–2.65).
- In the analyses of individual PPIs, none of the PPIs is associated with an increased MACE risk except for pantoprazole (HR 1.52, 95% CI 1.18–1.94).