title: Acute Coronary Syndromes, Gastrointestinal Protection, and Recommendations Regarding Concomitant Administration of Proton-Pump Inhibitors (Omeprazol/Esomeprazole) and Clopidogrel.
abstract: The Food and Drug Administration and the European Medicines Agency sent a warning in 2010 discouraging the concomitant use of clopidogrel with omeprazole or esomeprazole. The purpose is to know the gastroprotective approach in patients with acute coronary syndrome (ACS) and the level of follow-up of the alert. In 17 hospitals with catheterization laboratory in Spain, 1 per region, we studied 25 consecutive patients per hospital whose diagnosis of discharge since October 1, 2013, had been any type of ACS. We analyzed their baseline clinical profile, the gatroprotective agents at admission and discharge and the antiplatelet therapy at discharge. The number of patients included was 425: age 67.2 ± 12.5 years, women 29.8%, diabetes 36.5%. The patients presented unstable angina in 21.6%, non-ST-elevation myocardial infarction in 35.3% and ST-elevation myocardial infarction in 43.1%. Conservative approach was chosen in 17.9%, bare-metal stents 32.2%, ≥ 1 drug-eluting stent 48.5%, and surgery 1.4%. Aspirin was indicated in 1.9%, aspirin + clopidogrel 73.6%, aspirin + prasugrel 17.6%, and aspririn + ticagrelor 6.8%. Gastroprotective agents were present in 40.2% patients at admission and this percentage increased to 93.7% at discharge. Of the 313 (73.6%) on clopidogrel in 96 (30.6%) was combined with omeprazole and 3 (0.95%) with esomeprazole, whereas the most commonly used was pantoprazole with 190 patients (44.7%). In conclusion, almost the totality of the patients with an ACS receive gastroprotective agents at the moment of discharge, most of them with proton-pump inhibitors. In one every 3 cases of the patients who are on clopidogrel, the recommendation of the Food and Drug Administration and the European Medicines Agency is not followed.
authors.affiliation: Department of Cardiology, Hospital de Cabueñes, Gijón, Spain. Electronic address: inigo.lozano@gmail.com.
authors.forename: Iñigo
authors.initials: I
authors.lastname: Lozano
authors.affiliation: Department of Cardiology, Hospital Miguel Servet, Zaragoza, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Sanchez-Insa
authors.affiliation: Department of Cardiology, Hospital Virgen de la Macarena, Sevilla, Spain.
authors.forename: Sergio Rodríguez
authors.initials: SR
authors.lastname: de Leiras
authors.affiliation: Department of Cardiology, Hospital General, Alicante, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Carrillo
authors.affiliation: Department of Cardiology, Hospital de Navarra, Pamplona, Spain.
authors.forename: Valeriano
authors.initials: V
authors.lastname: Ruiz-Quevedo
authors.affiliation: Department of Cardiology, Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Pinar
authors.affiliation: Department of Cardiology, Hospital Insular, Las Palmas, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Gopar-Gopar
authors.affiliation: Department of Cardiology, Hospital Lucus Augusti, Lugo, Spain.
authors.forename: Jeremías
authors.initials: J
authors.lastname: Bayon
authors.affiliation: Department of Cardiology, Hospital Beltvitge, Barcelona, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Mañas
authors.affiliation: Department of Cardiology, Policlínica Gipuzkoa, San Sebastian, Spain.
authors.forename: Garikoitz
authors.initials: G
authors.lastname: Lasa
authors.affiliation: Department of Cardiology, Hospital Clínico, Salamanca, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: CruzGonzalez
authors.affiliation: Department of Cardiology, Hospital Doce Octubre, Madrid, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Hernandez
authors.affiliation: Department of Cardiology, Hospital de Cáceres, Caceres, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Fernandez-Portales
authors.affiliation: Department of Cardiology, Hospital General, Logroño, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Fernandez-Fernandez
authors.affiliation: Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Pérez-Serradilla
authors.affiliation: Department of Cardiology, Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: de la Torre Hernandez
authors.affiliation: Department of Cardiology, Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Gomez-Jaume
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000368:Aged; D000077144:Clopidogrel; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D064098:Esomeprazole / Q000008:administration & dosage*; D005260:Female; D005767:Gastrointestinal Diseases / Q000517:prevention & control*; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D012189:Retrospective Studies; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D000077144:Clopidogrel; D064098:Esomeprazole; D013988:Ticlopidine