Author + information
- Arun Kanmanthareddy1,
- Avanija Buddam1,
- Hemantha Koduri1,
- Abilash Balmuri1,
- Mahesh Anantha Narayanan1,
- Claire Hunter1,
- Venkata Alla1,
- Aryan Mooss1,
- Michael Del Core1 and
- Scott 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)|