Co-administration of P-CABs (HR 2.40; 95% CI 1.18-4.85) or PPIs (HR 1.38; 95% CI 1.17-1.63) with clopidogrel increased the risk of MACE compared to clopidogrel alone in ischemic stroke patients.
Cohort (n=16,064)
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Does co-administration of P-CABs or PPIs with clopidogrel increase the risk of MACE in patients with ischemic stroke?
Co-administration of P-CABs or PPIs with clopidogrel in patients with ischemic stroke is associated with a significantly increased risk of major adverse cardiovascular events and stroke recurrence.
Estimación del efecto: HR 2.40 (95% CI 1.18-4.85)
Abstract Background and aims This study evaluated the effectiveness and safety of potassium-competitive acid blockers (P-CABs) and proton pump inhibitors (PPIs) co-administered with clopidogrel in patients with ischemic stroke. Methods This population-based, longitudinal, retrospective cohort study used the Korean National Health Insurance Service database, covering 51.4 million individuals from 2016 to 2022. Propensity-score matching (PSM) compared the 6-month incidence of major adverse cardiovascular events (MACE, including MI, stroke recurrence, and all-cause mortality) among three cohorts: clopidogrel alone, clopidogrel+P-CAB, and clopidogrel+PPI. Results Between 2017 and 2021, 40 752 of 65 180 incident stroke patients (62.5%) received clopidogrel. A total of 6680 patients (16.4%) formed the clopidogrel-alone cohort, 578 (1.4%) the clopidogrel+P-CAB cohort, and 8806 (21.6%) the clopidogrel+PPI cohort. During the follow-up period, stroke recurred in 268 patients (4.0%) receiving clopidogrel alone, 26 patients (4.5%) receiving clopidogrel+P-CAB, and 431 patients (4.9%) receiving clopidogrel+PPI. After PSM, the clopidogrel+P-CAB cohort showed a higher risk of MACE (hazard ratio HR 2.40; 95% confidence interval CI 1.18–4.85) and stroke recurrence (HR 2.64; 95% CI 1.27–5.47) than the clopidogrel-alone cohort. The clopidogrel+PPI cohort also had an increased risk of MACE (HR 1.38; 95% CI 1.17–1.63) and stroke recurrence (HR 1.41; 95% CI 1.20–1.67) relative to clopidogrel alone. Conclusions Concomitant use of P-CABs or PPIs with clopidogrel was associated with an increased risk of ischemic events in patients with stroke. P-CABs or PPIs should therefore be prescribed cautiously for stroke patients treated with clopidogrel. Conflict of interest Kwang-Yeol Park: nothing to disclose; Jung-Hwa Hong: nothing to disclose; Seong-Hun Parknothing to disclose; Eun-Young Kimnothing to disclose;
Park et al. (Fri,) conducted a cohort in Ischemic stroke (n=16,064). Potassium-competitive acid blockers (P-CABs) or proton pump inhibitors (PPIs) co-administered with clopidogrel vs. Clopidogrel alone was evaluated on Major adverse cardiovascular events (MACE, including MI, stroke recurrence, and all-cause mortality) (HR 2.40, 95% CI 1.18-4.85). Co-administration of P-CABs (HR 2.40; 95% CI 1.18-4.85) or PPIs (HR 1.38; 95% CI 1.17-1.63) with clopidogrel increased the risk of MACE compared to clopidogrel alone in ischemic stroke patients.