Key result
Concomitant use of proton pump inhibitors with clopidogrel in post-percutaneous coronary intervention patients was associated with a increased risk of major adverse cardiovascular endpoints.
Why the study?
Data are conflicting regarding whether proton pump inhibitors diminish the efficacy of clopidogrel in patients receiving dual antiplatelet therapy after percutaneous coronary intervention.
Does the concomitant use of individual proton pump inhibitors increase the risk of adverse cardiovascular events in post-PCI patients on dual antiplatelet therapy with clopidogrel?
Meta-Analysis (n=131,412)
Yes
Does the concomitant use of individual proton pump inhibitors increase the risk of adverse cardiovascular events in post-PCI patients on dual antiplatelet therapy with clopidogrel?
Concomitant use of most proton pump inhibitors with clopidogrel in post-PCI patients is associated with an increased risk of MACE and MI, highlighting a potential drug-drug interaction that may diminish clopidogrel's efficacy.
Answers are grounded in this paper and cite their sources.
May warrant PPI caution in post-PCI clopidogrel patients; leaves open causality and need for randomized confirmation.
BACKGROUND: Data are conflicting on whether proton pump inhibitors (PPIs) diminish the efficacy of clopidogrel. We investigated individual PPIs and adverse cardiovascular events in postpercutaneous coronary intervention (PCI) patients on dual antiplatelet therapy with clopidogrel. METHODS: We searched Ovid-MEDLINE, EMBASE, and Cochrane from inception to March 2020 to identify studies that evaluated the efficacy and safety of clopidogrel added PPIs versus clopidogrel only in post-PCI patient. We extracted data from 28 studies for major adverse cardiovascular endpoints (MACE), myocardial infarction (MI), cardiovascular death, and gastrointestinal bleeding. Risk ratios (RR) and hazard ratios (HR) were pooled separately. RESULTS: Data were extracted on 131,412 patients from the 28 studies included. Concomitant use of PPI with clopidogrel was associated with increased risk of MACE (RR 1.30; 95% confidence interval [CI] 1.15-1.48; P < .001) and MI (RR 1.43; 95% CI 1.25-1.64; P < .001). Random-effects meta-analyses with individual PPIs demonstrated an increased risk of MACE in those taking pantoprazole (RR 1.31; 95% CI 1.07-1.61, P = .01) or lansoprazole (RR 1.35; 95% CI 1.19-1.54, P < .0001) compared with patients not on PPIs. Likewise, in adjusted analyses, the pooled HR of adjusted events for MACEs showed that the increased risk of MACEs was similar for 4 classes of PPIs but not for rabeprazole (HR: 1.32; 95% CI 0.69-2.53, P = .40). CONCLUSION: The post-PCI patients on dual antiplatelet therapy with clopidogrel in the PPI group were associated with higher risk of MACE and MI. Although the results for rabeprazole were not robust, it was the only PPI that did not yield a significantly increased risk of MACE.
No takes yet. Share an insight, caveat, or question.
A 2021 study conducted a meta-analysis in Post-percutaneous coronary intervention (PCI) on dual antiplatelet therapy with clopidogrel (n=131,412). Proton pump inhibitors (PPIs) vs. Clopidogrel without PPI was evaluated on Major adverse cardiovascular endpoints (MACE) (RR 1.30, 95% CI 1.15-1.48, p=<0.001). Concomitant use of proton pump inhibitors with clopidogrel in post-percutaneous coronary intervention patients was associated with a increased risk of major adverse cardiovascular endpoints.
Synapse has enriched 10 related papers. Consider them for comparative context: