Author + information
- S1936879815020920-53cdf714d81585b675a07b2e8f37d597Arun Kanmanthareddy1,
- S1936879815020920-cf998dc3c817354ce0b016da92655507Avanija Buddam1,
- S1936879815020920-f89794bae7903c126efb0fdf2653850cHemantha Koduri1,
- S1936879815020920-18cb96eb8613a22a10e0d3aa5b3abe16Abilash Balmuri1,
- S1936879815020920-789e81eb4a09bc497a6333e447cf6225Mahesh Anantha Narayanan1,
- S1936879815020920-b8df8873973e23f4de37572c193ad4b6Claire Hunter1,
- S1936879815020920-7dbedd2cbccdfc602d9801708ea549cfVenkata Alla1,
- S1936879815020920-6983ecaccba5119d5435ecff3c4873ecAryan Mooss1,
- S1936879815020920-9478f2f1e15610ffde9514d60d73c5e1Michael Del Core1 and
- S1936879815020920-5292544d54e6185304ba63fd4d6cbc68Scott Lilly2
Evidence on cardiovascular outcomes with concomitant pharmacotherapy with proton pump inhibitors (PPI) and clopidogrel is mixed and varies across studies. We performed a meta-analysis of studies examining this relationship in both matched and unmatched cohorts.
PubMed, Google Scholar and EBSCO databases were searched electronically to identify studies using concomitant PPI’s and clopidogrel. Data on endpoints of mortality, myocardial infarction (MI), stroke (CVA), stent thrombosis and clinically driven revascularization was extracted. Pooled risk ratio (RR) with 95% confidence intervals (CI) was estimated using random effects model.
A total of 24 studies (7 matched) were included. In the matched cohort, 7,962 and 12,225 patients were included in the PPI and non-PPI groups respectively. In the matched cohort only group there was no difference in the outcomes of mortality, MI, revascularization, stent thrombosis and CVA (Figure 1). However, in the unmatched cohort group, mortality, MI, and revascularization were significantly higher in the PPI group compared to the non-PPI group. The risk of stent thrombosis and CVA risk was not different in the two groups.
Adverse cardiovascular outcomes were not significantly different in the PPI and clopidogrel group in the matched cohort but not in the unmatched cohort. We speculate that PPI as a class do not influence the above outcomes but may be dependent on the type of PPI, dose of PPI and dose of clopidogrel used.
|Outcome||Matched Cohort RR (95% CI)||Unmatched Cohort RR (95% CI)|
|Mortality||1.19 (0.79 - 1.80)||1.40 (1.21 - 1.62)|
|Myocardial Infarction||1.11 (0.95 - 1.29)||1.41 (1.20 - 1.66)|
|Clinically driven revascularization||1.04 (0.80 - 1.34)||1.66 (1.15 - 2.39)|
|Stroke||1.46 (0.67 - 3.20)||1.35 (0.99 - 1.86)|
|Stent thrombosis||1.33 (0.84 - 2.11)||1.12 (0.61 - 2.06)|