Effect of concomitant use of clopidogrel and proton pump inhibitors after percutaneous coronary intervention.
The aim of the present study was to analyze the effect of drug exposure patterns of clopidogrel and proton pump inhibitors (PPIs) on the clinical outcomes after percutaneous coronary intervention (PCI). Previous analyses predominantly included discharge medications and did not explore the effect of the drug exposure patterns. We analyzed all-cause death, nonfatal myocardial infarction, repeat revascularization, and major adverse cardiovascular events (MACE) in a cohort of 23,200 post-PCI patients (January 2003 to December 2008) using a multivariate adjusted Cox model and propensity-matched case-control analysis. The adjusted hazard ratio for MACE on PPI according to the exposure patterns of clopidogrel after PCI for 6 years was 1.24 (95% confidence interval [CI] 1.11 to 1.38) and 1.12 (95% CI 1.03 to 1.22) for "continuous" (consistent clopidogrel with or without PPIs) and "switched" (clopidogrel with or without varying PPIs) respectively. However, the propensity score adjusted odds ratios for MACE on PPI use was 0.97 (95% CI 0.65 to 1.44) for "continuous" and 1.04 (95% CI 0.87 to 1.25) for "switched." Moreover, in the first year after PCI, the use of "rescue" (≤30 days before MACE) nitroglycerin was greater in the patients taking clopidogrel and PPIs than in those taking clopidogrel alone, as was the overall use of rescue PPIs (p <0.001). In conclusion, PPI use in clopidogrel-treated post-PCI patients was not associated with an increased risk of MACE after controlling for the confounding effect of PPI use with propensity matching. A potential for the misdiagnosis of angina symptoms and rescue use of nitroglycerin and PPIs in post-PCI patients exists, a finding that might have confounded previous observational analyses.
Veterans Affairs North Texas Health Care System, Dallas, TX, USA. Subhash.banerjee@va.gov
Subhash
S
Banerjee
Rick A
RA
Weideman
Mark W
MW
Weideman
Bertis B
BB
Little
Kevin C
KC
Kelly
Jennifer T
JT
Gunter
Kathryn L
KL
Tortorice
Michelle
M
Shank
Byron
B
Cryer
Robert F
RF
Reilly
Sunil V
SV
Rao
Adnan
A
Kastrati
James A
JA
de Lemos
Emmanouil S
ES
Brilakis
Deepak L
DL
Bhatt
D015906:Angioplasty, Balloon, Coronary; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D000077144:Clopidogrel; D003327:Coronary Disease / Q000628:therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D015607:Stents; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014728:Veterans
D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine